CPT code 43611: Stomach lesion excision, extensive excision2026 Medicare rate & RVUs in Florida
Report this code for extensive transabdominal removal of a stomach lesion through a gastrotomy, when the operation is more than a limited excision or biopsy.
CMS doesn’t publish an office rate for 43611 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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On this page 9 sections
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 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 | $1,287.01 |
| Miami, FL | Unavailable | $1,415.40 |
| Rest of Florida | Unavailable | $1,218.26 |
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.
How the rate is built · 43611
RVUs × geographic indexes × conversion factor
Work19.87
19.87 RVUs× 1.000 GPCI
Practice expense9.57
9.57 RVUs× 1.000 GPCI
Malpractice4.96
4.96 RVUs× 1.000 GPCI
Adjusted RVUs
34.4000
Conversion factor
$33.4009
Medicare rate
$1,148.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43611
43611 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43611
Stomach lesion excision, extensive excision
| 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 · 43611
Stomach lesion excision, extensive excision
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
43611 without 51 · national facility
$1,148.99
Stomach lesion excision, extensive excision
43611-51 · Second procedure: 50%
$574.50
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%).
43611 compared with similar codes
Compare codes · National
4 codes, side by side
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.
43611 billing questions
How does this differ from 43610?
Both describe transabdominal excision of a stomach lesion through a gastrotomy. Choose 43611 for an extensive excision and 43610 for a limited one, based on the operative work documented.
When should a stomach biopsy code be used instead?
Use 43605 when the surgeon obtains tissue for diagnosis rather than performing extensive lesion removal. A biopsy does not represent the excision described by 43611.
Does the 90-day global include postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
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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