CPT code 43621: Total gastrectomy, roux-en-Y reconstruction2026 Medicare rate & RVUs in Tennessee
Report this service for complete stomach removal followed by Roux-en-Y reconstruction, commonly performed for gastric malignancy or other disease requiring total gastrectomy.
In Tennessee, Medicare pays $1,896.86 for 43621 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43621 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 43621 covers
The operation removes the stomach in its entirety and restores continuity by connecting the esophagus to a Roux-en-Y limb of small intestine. General surgeons and surgical oncologists perform it in an operating room, commonly for gastric cancer or other disease requiring complete removal. The documented reconstruction distinguishes this service from total gastrectomy without that configuration or with an intestinal pouch.
Report the code when the operative record supports both complete stomach removal and Roux-en-Y reconstruction; a partial resection or lesion excision is not enough. This major surgery has 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 for this single-organ procedure. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
How Tennessee compares for 43621
Across 109 of 109 payment localities, the facility rate for 43621 runs from $1,845.45 in Wisconsin to $2,619.58 in Alaska. Tennessee pays $1,896.86. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Tennessee · this page$1,896.86
- Los Angeles, CA · California$2,121.99+$225.13
- Washington, DC area · District of Columbia$2,283.01+$386.15
- Miami, FL · Florida$2,610.61+$713.75
- Chicago, IL · Illinois$2,525.99+$629.13
- Manhattan, NY · New York$2,442.75+$545.89
- Alaska · Alaska$2,619.58+$722.72
Other areas in Tennessee first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $1,890.09 |
| ArkansasArkansas | — | $1,865.79 |
| ArizonaArizona | — | $2,029.72 |
| Bakersfield, CACalifornia | — | $2,034.15 |
| Chico, CACalifornia | — | $2,007.73 |
| El Centro, CACalifornia | — | $2,009.36 |
| Fresno, CACalifornia | — | $2,007.73 |
| Hanford, CACalifornia | — | $2,007.73 |
| Madera, CACalifornia | — | $2,007.73 |
| Merced, CACalifornia | — | $2,007.73 |
| Modesto, CACalifornia | — | $2,007.73 |
| Napa, CACalifornia | — | $2,163.83 |
| Oxnard, CACalifornia | — | $2,091.39 |
| Redding, CACalifornia | — | $2,007.73 |
| Rest of CaliforniaCalifornia | — | $2,007.73 |
| Riverside, CACalifornia | — | $2,112.57 |
| Sacramento, CACalifornia | — | $2,064.19 |
| Salinas, CACalifornia | — | $2,055.84 |
| San Diego, CACalifornia | — | $2,074.19 |
| Marin County, CACalifornia | — | $2,232.96 |
| San Francisco, CACalifornia | — | $2,221.85 |
| San Benito County, CACalifornia | — | $2,292.71 |
| Santa Clara County, CACalifornia | — | $2,247.30 |
| San Luis Obispo, CACalifornia | — | $2,028.27 |
| Santa Cruz, CACalifornia | — | $2,069.72 |
| Santa Maria, CACalifornia | — | $2,055.32 |
| Santa Rosa, CACalifornia | — | $2,087.51 |
| Stockton, CACalifornia | — | $2,007.73 |
| Vallejo, CACalifornia | — | $2,147.83 |
| Visalia, CACalifornia | — | $2,007.73 |
| Yuba City, CACalifornia | — | $2,007.73 |
| ColoradoColorado | — | $2,066.04 |
| ConnecticutConnecticut | — | $2,222.69 |
| DelawareDelaware | — | $2,059.28 |
| Fort Lauderdale, FLFlorida | — | $2,361.72 |
| Rest of FloridaFlorida | — | $2,234.86 |
| Atlanta, GAGeorgia | — | $2,168.73 |
| Rest of GeorgiaGeorgia | — | $2,102.70 |
| Hawaii, Guam, HIHawaii | — | $2,019.48 |
| IowaIowa | — | $1,853.99 |
| IdahoIdaho | — | $1,881.20 |
| East St. Louis, ILIllinois | — | $2,384.59 |
| Rest of IllinoisIllinois | — | $2,233.92 |
| Suburban Chicago, ILIllinois | — | $2,365.65 |
| IndianaIndiana | — | $1,888.79 |
| KansasKansas | — | $1,883.69 |
| KentuckyKentucky | — | $2,010.78 |
| New Orleans, LALouisiana | — | $2,107.81 |
| Rest of LouisianaLouisiana | — | $2,022.92 |
| Metropolitan Boston, MAMassachusetts | — | $2,201.07 |
| Rest of MassachusettsMassachusetts | — | $2,071.16 |
| Baltimore area, MDMaryland | — | $2,224.45 |
| Rest of MarylandMaryland | — | $2,083.38 |
| Rest of MaineMaine | — | $1,929.88 |
| Southern Maine, MEMaine | — | $1,966.73 |
| Detroit, MIMichigan | — | $2,298.94 |
| Rest of MichiganMichigan | — | $2,092.15 |
| MinnesotaMinnesota | — | $1,875.45 |
| Metropolitan Kansas City, MOMissouri | — | $2,054.92 |
| Metropolitan St. Louis, MOMissouri | — | $2,069.29 |
| Rest of MissouriMissouri | — | $2,017.16 |
| MississippiMississippi | — | $1,939.91 |
| MontanaMontana | — | $2,090.91 |
| North CarolinaNorth Carolina | — | $1,941.64 |
| North DakotaNorth Dakota | — | $1,897.53 |
| NebraskaNebraska | — | $1,851.60 |
| New HampshireNew Hampshire | — | $2,070.31 |
| Northern New JerseyNew Jersey | — | $2,271.30 |
| Rest of New JerseyNew Jersey | — | $2,218.68 |
| New MexicoNew Mexico | — | $2,117.58 |
| NevadaNevada | — | $2,037.49 |
| NYC suburbs and Long Island, NYNew York | — | $2,544.17 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $2,263.47 |
| Queens, NYNew York | — | $2,405.26 |
| Rest of New YorkNew York | — | $1,970.66 |
| OhioOhio | — | $2,052.62 |
| OklahomaOklahoma | — | $1,967.61 |
| Portland, OROregon | — | $2,081.55 |
| Rest of OregonOregon | — | $1,992.64 |
| Metropolitan Philadelphia, PAPennsylvania | — | $2,197.36 |
| Rest of PennsylvaniaPennsylvania | — | $2,034.43 |
| Puerto RicoPuerto Rico | — | $2,091.92 |
| Rhode IslandRhode Island | — | $2,096.51 |
| South CarolinaSouth Carolina | — | $2,006.27 |
| South DakotaSouth Dakota | — | $1,874.66 |
| Austin, TXTexas | — | $2,084.60 |
| Beaumont, TXTexas | — | $2,025.38 |
| Brazoria, TXTexas | — | $2,025.70 |
| Dallas, TXTexas | — | $2,054.85 |
| Fort Worth, TXTexas | — | $2,054.32 |
| Galveston, TXTexas | — | $2,042.33 |
| Houston, TXTexas | — | $2,221.34 |
| Rest of TexasTexas | — | $2,035.52 |
| UtahUtah | — | $2,029.59 |
| VirginiaVirginia | — | $1,987.41 |
| Virgin Islands, VIUnited States Virgin Islands | — | $2,091.92 |
| VermontVermont | — | $1,925.42 |
| Rest of WashingtonWashington | — | $2,055.54 |
| King County, WAWashington | — | $2,204.57 |
| WisconsinWisconsin | — | $1,845.45 |
| West VirginiaWest Virginia | — | $2,169.79 |
| WyomingWyoming | — | $2,006.63 |
43621 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 43621 rate is calculated
Each of 43621’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 · 43621
RVUs × geographic indexes × conversion factor
Work38.54
38.54 RVUs× 1.000 GPCI
Practice expense14.30
14.30 RVUs× 1.000 GPCI
Malpractice9.78
9.78 RVUs× 1.000 GPCI
Adjusted RVUs
62.6200
Conversion factor
$33.4009
Medicare rate
$2,091.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Tennessee inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,266
- Code
- 43621
- Physician work
- 38.54
- Practice expense
- 14.30
- Malpractice
- 9.78
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 38.54 | × 1.000 | 38.5400 |
| Practice expense | 14.30 | × 0.909 | 12.9987 |
| Malpractice | 9.78 | × 0.537 | 5.2519 |
| Total RVUs | 56.7906 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$1896.86
Facility: (38.54 × 1 + 14.3 × 0.909 + 9.78 × 0.537) × $33.4009 = $1896.86
Payment rules and modifiers for 43621
43621 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43621
Total gastrectomy, roux-en-Y reconstruction
| 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 · 43621
Total gastrectomy, roux-en-Y reconstruction
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
43621 without 51 · national facility
$2,091.56
Total gastrectomy, roux-en-Y reconstruction
43621-51 · Second procedure: 50%
$1,045.78
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%).
How 43621 has changed in Tennessee
43621 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1,896.86 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,896.86 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,896.86 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,896.86 | RVU26A |
| 2025-10-01 | Not available in this setting | $2,004.41 | RVU25D |
| 2025-07-01 | Not available in this setting | $2,004.41 | RVU25C |
| 2025-04-01 | Not available in this setting | $2,004.41 | RVU25B |
| 2025-01-01 | Not available in this setting | $2,004.41 | RVU25A |
| 2024-10-01 | Not available in this setting | $2,048.16 | RVU24D |
| 2024-07-01 | Not available in this setting | $2,048.16 | RVU24C |
| 2024-04-01 | Not available in this setting | $2,048.16 | RVU24B |
| 2024-03-09 | Not available in this setting | $2,048.16 | RVU24AR |
| 2024-01-01 | Not available in this setting | $2,014.73 | RVU24A |
| 2023-10-01 | Not available in this setting | $2,067.53 | RVU23D |
| 2023-07-01 | Not available in this setting | $2,067.53 | RVU23C |
| 2023-04-01 | Not available in this setting | $2,067.53 | RVU23B |
| 2023-01-01 | Not available in this setting | $2,067.53 | RVU23A |
| 2022-10-01 | Not available in this setting | $2,099.64 | RVU22D |
| 2022-07-01 | Not available in this setting | $2,099.64 | RVU22C |
| 2022-04-01 | Not available in this setting | $2,099.64 | RVU22B |
| 2022-01-01 | Not available in this setting | $2,099.64 | RVU22A |
| 2021-10-01 | Not available in this setting | $2,105.30 | RVU21D |
| 2021-07-01 | Not available in this setting | $2,105.30 | RVU21C |
| 2021-04-01 | Not available in this setting | $2,105.30 | RVU21B |
| 2021-01-01 | Not available in this setting | $2,105.30 | RVU21A |
| 2020-10-01 | Not available in this setting | $2,159.43 | RVU20D |
| 2020-07-01 | Not available in this setting | $2,159.43 | RVU20C |
| 2020-04-01 | Not available in this setting | $2,159.43 | RVU20B |
| 2020-01-01 | Not available in this setting | $2,159.43 | RVU20A |
| 2019-10-01 | Not available in this setting | $2,157.18 | RVU19D |
| 2019-07-01 | Not available in this setting | $2,157.18 | RVU19C |
| 2019-04-01 | Not available in this setting | $2,157.18 | RVU19B |
| 2019-01-01 | Not available in this setting | $2,157.18 | RVU19A |
| 2018-10-01 | Not available in this setting | $2,148.38 | RVU18D |
| 2018-07-01 | Not available in this setting | $2,148.38 | RVU18C |
| 2018-04-01 | Not available in this setting | $2,148.38 | RVU18B |
| 2018-01-01 | Not available in this setting | Rate data unavailable | RVU18AR1 |
| 2017-10-01 | Not available in this setting | Rate data unavailable | RVU17D |
| 2017-07-01 | Not available in this setting | Rate data unavailable | RVU17C |
| 2017-04-01 | Not available in this setting | Rate data unavailable | RVU17B |
| 2017-01-01 | Not available in this setting | Rate data unavailable | RVU17A |
| 2016-10-01 | Not available in this setting | Rate data unavailable | RVU16D |
| 2016-07-01 | Not available in this setting | Rate data unavailable | RVU16C |
| 2016-04-01 | Not available in this setting | Rate data unavailable | RVU16B |
| 2016-01-01 | Not available in this setting | Rate data unavailable | RVU16A |
| 2015-10-01 | Not available in this setting | Rate data unavailable | RVU15D |
| 2015-07-01 | Not available in this setting | Rate data unavailable | RVU15C |
| 2015-04-01 | Not available in this setting | Rate data unavailable | RVU15B |
| 2015-01-01 | Not available in this setting | Rate data unavailable | RVU15A |
| 2014-10-01 | Not available in this setting | Rate data unavailable | RVU14D |
| 2014-07-01 | Not available in this setting | Rate data unavailable | RVU14C |
| 2014-04-01 | Not available in this setting | Rate data unavailable | RVU14B |
| 2014-01-01 | Not available in this setting | Rate data unavailable | RVU14A |
| 2013-10-01 | Not available in this setting | Rate data unavailable | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the Tennessee rate applies
Tennessee is a Medicare payment area, not a city. Our Census mapping connects it to 504 cities and communities in Tennessee. Some span more than one payment area; confirm with the service ZIP.
- Adams
- Adamsville
- Alamo
- Alcoa
- Alexandria
- Algood
- Allardt
- Altamont
43621 billing questions
How is this distinguished from 43620?
Use 43621 when the total gastrectomy includes Roux-en-Y reconstruction. Code 43620 describes total gastrectomy without that reconstruction.
When is 43622 a better fit?
Use 43622 when the total gastrectomy includes formation of an intestinal pouch. The reconstruction documented in the operative report determines the choice.
Can a partial gastrectomy be reported with this code?
No. This code represents removal of the entire stomach; a resection that leaves part of the stomach is represented by an appropriate partial-gastrectomy code.
Should modifier 50 be used?
No. The code represents removal of a single stomach, so modifier 50 is inappropriate.
What postoperative care is included?
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 payment is not permitted.
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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