CPT code 43611: Stomach lesion excision, extensive excision2026 Medicare rate & RVUs

Medicare pays $1,148.99 for 43611 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 43611 covers

A surgeon uses a transabdominal approach to open the stomach and remove an extensive lesion, then closes the stomach. The operation is performed in a surgical setting, commonly by a general or gastrointestinal surgeon. It differs from taking a tissue sample for diagnosis and from removing a portion or all of the stomach as a gastrectomy.

Choose this code when the operative report supports extensive local lesion removal; document the lesion, the extent of excision, the gastrotomy, and the work performed. Medicare 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 subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 43611 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

43611 rates by state

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

How the 43611 rate is calculated

Each of 43611’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 43611

43611 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

43611 compared with similar codes

How to choose

43610Gastric lesion excisionWithout partial gastrectomy

Both involve transabdominal lesion excision through a gastrotomy. The distinction is limited versus extensive excision, supported by the operative report.

43605Stomach biopsyOpen abdominal approach

43605 represents stomach biopsy for tissue diagnosis. Use 43611 when the surgeon performs extensive removal of the lesion rather than sampling it.

43631Partial gastrectomyDistal, gastroduodenostomy

43631 describes distal partial gastrectomy, which removes a portion of the stomach. 43611 is for extensive local lesion excision, not a partial gastrectomy.

Codes related to 43611

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