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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the EsophagusCPT cpt-43121-transthoracic-esophagectomy-distal-two-thirds
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    CPT 43121: Distal Two-Thirds Esophagectomy via Chest Incision

    Medicare pays $2691 on average nationally for this procedure.

    CPT code 43121 describes a surgical esophagectomy removing the distal two-thirds of the esophagus via a chest incision, often including partial gastrectomy with reattachment of the remaining stomach to the residual esophagus and possible widening of the gastric outlet; service type: surgical resection of the esophagus; typical site of service: inpatient hospital operating room/thoracic surgery setting.

    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 typical patient is a 62-year-old male with progressive dysphagia, weight loss, and reflux symptoms who is diagnosed with a distal esophageal malignancy or severe corrosive/peptic stricture involving the lower two-thirds of the esophagus. After preoperative staging (endoscopy with biopsy, CT chest/abdomen, and anesthesia evaluation), the patient is brought to the operating room for a transthoracic esophagectomy with gastric conduit reconstruction. The surgeon performs a right or left thoracotomy (chest incision) to resect the distal two-thirds of the esophagus and may perform a proximal gastrectomy (partial stomach resection) if tumor margins warrant. The remaining stomach is mobilized, brought into the chest or neck, and anastomosed to the remaining proximal esophagus; pyloroplasty or pyloromyotomy may be performed to widen the gastric outlet if indicated. Typical perioperative workflow includes pre-op informed consent, general anesthesia with endotracheal intubation, chest tube placement, postoperative ICU monitoring for ventilatory support and hemodynamic management, enteral nutrition planning (jejunostomy or nasoenteric tube), pain control, and surveillance for complications such as anastomotic leak, pneumonia, or recurrent laryngeal nerve injury.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43280Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washingPreoperative diagnostic endoscopy and biopsy to obtain tissue diagnosis and assess lesion extent.
    43295Esophagogastrectomy, esophagectomy, or resection of esophagus with gastrectomy, thoracotomy and/or thoracoabdominal approach; limited (less than total esophagectomy)Alternative or related resection code for partial esophagectomy with gastrectomy when procedure specifics differ.
    49000Exploration, abdominal, cavity, peritoneal; diagnostic, with or without collection of specimen(s)Performed when abdominal exploration or staging is required during the same setting.
    43843Laparoscopy, surgical, gastric restrictive procedure; with gastric plicationNot routinely combined but listed as related upper GI gastric procedures; included here as a commonly billed gastric operation (use with caution based on clinical scenario).
    43820Gastric bypass, Roux-en-Y, with small intestine reconstruction (for comparison of gastric conduit construction techniques)Not commonly performed concurrently but relevant when discussing gastric reconstruction or multivisceral procedures.

    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…
    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…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    208000000X
    207L00000X
    207RH0000X
    246Q00000X
    225C00000X
    2084A2900X
    347C00000X

    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-43118-ESOPHAGECTOMY-DISTAL-TWO-THIRDS-WITH-INTESTINAL-INTERPOSITION

    CPT 43118: Esophagectomy with Reconstruction (Thoracoabdominal)

    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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