CPT code 43605: Stomach biopsy, open abdominal approach2026 Medicare rate & RVUs in Florida
An open abdominal gastric biopsy obtains tissue for diagnosis when the surgeon samples the stomach during laparotomy rather than using a peroral approach.
CMS doesn’t publish an office rate for 43605 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 43605 covers
Code 43605 represents diagnostic tissue sampling of the stomach through an open abdominal incision. The surgeon exposes the stomach during laparotomy and removes a specimen for histologic evaluation, such as when an abnormal area requires tissue diagnosis and open access is the approach used. This is an operative biopsy, not an excision intended to remove a gastric lesion as treatment. General or gastrointestinal surgeons typically perform the service in an operating room.
Report the code when the operative record supports an open approach and gastric tissue sampling. Document the indication, sampled site, findings, and specimen submitted. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 43605 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $900.28 |
| Miami, FL | Unavailable | $993.05 |
| Rest of Florida | Unavailable | $850.46 |
How the 43605 rate is calculated
Each of 43605’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43605
RVUs × geographic indexes × conversion factor
Work13.38
13.38 RVUs× 1.000 GPCI
Practice expense7.01
7.01 RVUs× 1.000 GPCI
Malpractice3.58
3.58 RVUs× 1.000 GPCI
Adjusted RVUs
23.9700
Conversion factor
$33.4009
Medicare rate
$800.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43605
43605 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43605
Stomach biopsy, open abdominal approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43605
Stomach biopsy, open abdominal approach
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43605 without 51 · national facility
$800.62
Stomach biopsy, open abdominal approach
43605-51 · Second procedure: 50%
$400.31
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43605 compared with similar codes
Compare codes · National
43605 vs 43610 vs 88305: Medicare rates
How to choose
- 43610Gastric lesion excisionWithout partial gastrectomy
- 43605 represents tissue sampling for diagnosis. Choose 43610 when the service is excision of a stomach lesion rather than biopsy alone.
- 88305Tissue pathology examLevel IV specimen
- 88305 represents the pathology examination of a specimen. Code 43605 represents the surgeon’s operative procurement of gastric tissue.
43605 billing questions
How does 43605 differ from 43600?
43605 is for gastric tissue sampling through an open abdominal approach. Code 43600 describes biopsy by mouth.
When is 43610 a better choice?
Use 43605 for diagnostic tissue sampling. Code 43610 is for excision of a stomach lesion rather than a biopsy alone.
What documentation supports 43605?
The operative report should establish the open approach, the reason for sampling, the stomach site sampled, and the tissue obtained.
Are related postoperative visits included?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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