CPT code 43610: Gastric lesion excision, without partial gastrectomy2026 Medicare rate & RVUs

Medicare pays $919.86 for 43610 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 43610 covers

A surgeon removes a localized lesion from the stomach through an operative approach, opening the stomach when needed to reach the site. A focal gastric ulcer or other localized lesion may be excised while avoiding a formal partial gastrectomy. General surgeons typically perform the procedure in a hospital operating room; Medicare claims data show facility rather than office services.

Choose this code for excision, not tissue sampling alone, and distinguish it from 43611 when the operation includes partial gastrectomy. The operative report should identify the lesion, the excision performed, and whether gastric resection was part of the procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Do not append modifier 50 for this stomach procedure. 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 43610 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

43610 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 43610 rate is calculated

Each of 43610’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.

Payment rules and modifiers for 43610

43610 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

43610 compared with similar codes

How to choose

43605Stomach biopsyOpen abdominal approach

43605 is for biopsy by laparotomy, when tissue is sampled. 43610 is for operative removal of the localized lesion.

43611Stomach lesion excisionExtensive excision

Choose 43611 when excision of the local lesion includes partial gastrectomy; 43610 describes local excision without that resection.

43631Partial gastrectomyDistal, gastroduodenostomy

43631 describes distal partial gastrectomy with gastroduodenostomy. It represents a defined gastric resection and reconstruction, not local lesion excision.

43659Laparoscopic stomach procedureUnlisted procedure

43659 is an unlisted code for laparoscopic stomach procedures without a specific code. 43610 describes open local lesion excision.

Codes related to 43610

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates