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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the EsophagusCPT cpt-43118-esophagectomy-distal-two-thirds-with-intestinal-interposition
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    CPT 43118: Esophagectomy with Reconstruction (Thoracoabdominal)

    Medicare pays $3363 on average nationally for this procedure.

    CPT code 43118 describes a surgical esophagectomy removing the distal two-thirds of the esophagus, with possible partial gastrectomy and reconstruction using a segment of colon or small intestine, performed via combined abdominal and thoracic incisions; service type: major surgical resection with reconstruction, typical site of service: inpatient hospital (operating room with post‑operative inpatient care).

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with a distal esophageal adenocarcinoma involving the lower two-thirds of the esophagus presents with progressive dysphagia, weight loss, and intermittent aspiration. After staging studies (endoscopic ultrasound, CT chest/abdomen, PET as indicated) demonstrate localized disease without unresectable metastasis, the multidisciplinary team schedules a transthoracic esophagectomy with gastric or intestinal conduit reconstruction. The procedure described by 43118 (resection of the lower two-thirds of the esophagus with possible partial gastrectomy and replacement using colon or small bowel, requiring both abdominal and thoracic incisions) is performed under general anesthesia in an operating room with postoperative care in a surgical intensive care or step-down unit.

    Preoperative workflow includes anesthesia evaluation, informed consent detailing risks (anastomotic leak, pulmonary complications), optimization of nutrition, and marking for possible staged or combined approaches. Intraoperative workflow involves thoracic and abdominal access, mobilization and resection of the diseased esophagus, preparation of the colonic or small bowel conduit, creation of the esophagointestinal anastomosis, hemostasis, and placement of drains. Postoperative workflow includes extubation planning, postoperative analgesia, early pulmonary hygiene, imaging (contrast swallow) to assess anastomotic integrity before initiating oral intake, and coordination of oncology and nutrition for adjuvant therapy and enteral feeding needs.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99223Initial hospital care, typically 70 minutes or morePreoperative and postoperative inpatient evaluation and management for complex surgical patients undergoing 43118.
    43280Endoscopic ultrasound, esophagus, diagnosticPreoperative staging procedure often used to assess tumor depth and regional lymph nodes prior to esophagectomy.
    38999Unlisted procedure, hemic/blood vessel?Data not available in the input.
    51702Placement of temporary indwelling urethral catheterIntraoperative or perioperative urinary catheter placement commonly performed for fluid management during major thoracoabdominal surgery.
    76937Ultrasound guidance for vascular accessUsed intraoperatively or perioperatively for central venous or arterial line placement to optimize hemodynamic monitoring during 43118.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2086S0102X
    207T00000X
    207K00000X
    385HR2060X
    344600000X
    202K00000X
    152WX0102X
    207RS0010X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-43100-CERVICAL-ESOPHAGEAL-LESION-EXCISION

    CPT 43100: Excision of Lesion From Cervical Esophagus

    CPT-43101-ESOPHAGEAL-LESION-EXCISION-THORACIC-ABDOMINAL-APPROACH

    CPT 43101: Excision of Esophageal Lesion via Thoracic or Abdominal Incision

    CPT-43107-ESOPHAGECTOMY-CERVICAL-ESOPHAGOGASTRIC-RECONSTRUCTION

    CPT 43107: Transcervical Esophagectomy with Gastric-Pharyngeal Reconstruction

    CPT-43108-ESOPHAGECTOMY-NON-THORACOTOMY-WITH-BOWEL-GRAFT-RECONSTRUCTION

    CPT 43108: Esophagectomy with Small Bowel or Colon Interposition, Nonthoracotomy

    CPT-43112-MCKEOWN-TRI-INCISIONAL-ESOPHAGECTOMY

    CPT 43112: McKeown (Tri-incisional) Total Esophagectomy with Gastric Pull-up

    CPT-43113-ESOPHAGECTOMY-WITH-INTESTINAL-GRAFT-THROUGH-CHEST

    CPT 43113: Esophagectomy with Small Bowel or Colon Reconstruction, Thoracic Approach

    CPT-43116-ESOPHAGECTOMY-WITH-INTESTINAL-GRAFT-RECONSTRUCTION

    CPT 43116: Esophagectomy with Intestinal Graft in Cervical Esophagus

    CPT-43117-ESOPHAGECTOMY-DISTAL-TWO-THIRDS-WITH-GASTRIC-RECONSTRUCTION

    CPT 43117: Subtotal Esophagectomy with Gastric Conduit, Abdominal and Thoracic Approach

    CPT-43121-TRANSTHORACIC-ESOPHAGECTOMY-DISTAL-TWO-THIRDS

    CPT 43121: Distal Two-Thirds Esophagectomy via Chest Incision

    CPT-43122-PARTIAL-ESOPHAGECTOMY-ESOPHAGOGASTROSTOMY

    CPT 43122: Partial Esophagectomy with Esophagogastric Anastomosis

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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