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CPT code 43644: Gastric bypass, roux-en-Y, laparoscopic2026 Medicare rate & RVUs

Reports laparoscopic bariatric surgery that creates a small stomach pouch and routes it to the small intestine through a Roux-en-Y connection.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.9K Medicare services in 2024

Medicare pays $1,618.27 for 43644 nationally in a facility.

Medicare rate · 43644

Gastric bypass, roux-en-Y, laparoscopic

Office or facility?

Work RVUs
28.67
Total RVUs
48.45
Global days
090

National rate · 2026

$1,618.27

Facility setting, before claim adjustments.

See every locality for 43644 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 43644 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 43644 covers

A bariatric surgeon performs this operation laparoscopically to create a small stomach pouch and connect it to the small intestine in a Roux-en-Y configuration. The reconstruction changes the route food takes through the stomach and intestine. It is commonly performed in a hospital for patients undergoing surgical treatment of obesity. The operative report should describe the laparoscopic approach and the pouch and intestinal connections created.

Report the code for the completed laparoscopic Roux-en-Y operation, rather than separately coding its component steps. 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, Medicare pays the highest-valued procedure in full and reduces other procedures to 50%. Modifier 50 is inappropriate for this single digestive-tract reconstruction. An assistant at surgery may be paid; co-surgeons are paid only with 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 43644 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

43644 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,456.84
AlaskaUnavailable$2,008.86
ArizonaUnavailable$1,568.96
ArkansasUnavailable$1,437.34
Atlanta, GAUnavailable$1,678.93
Austin, TXUnavailable$1,614.62
Bakersfield, CAUnavailable$1,575.62
Baltimore area, MDUnavailable$1,723.67
Beaumont, TXUnavailable$1,563.66
Brazoria, TXUnavailable$1,566.14

43644 rates by state

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

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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
43644 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 43644 rate is calculated

Each of 43644’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 · 43644

RVUs × geographic indexes × conversion factor

Office or facility?

Work28.67

28.67 RVUs× 1.000 GPCI

Practice expense12.14

12.14 RVUs× 1.000 GPCI

Malpractice7.64

7.64 RVUs× 1.000 GPCI

Adjusted RVUs

48.4500

Conversion factor

$33.4009

Medicare rate

$1,618.27

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 43644

43644 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43644

Gastric bypass, roux-en-Y, laparoscopic

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 43644

Gastric bypass, roux-en-Y, laparoscopic

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

43644 without 51 · national facility

$1,618.27

Gastric bypass, roux-en-Y, laparoscopic

43644-51 · Second procedure: 50%

$809.14

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%).

When to use modifier 51

43644 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43644

    Gastric bypass, roux-en-Y, laparoscopic28.67 wRVU

    Not priced

  • 43645

    Gastric bypass, small-intestine reconstruction30.74 wRVU

    Not priced

  • 43846

    Gastric bypass, short-limb Roux-en-Y26.72 wRVU

    Not priced

  • 43775

    Sleeve gastrectomy, laparoscopic approach19.87 wRVU

    Not priced

How to choose

43645Gastric bypassSmall-intestine reconstruction
Use 43644 for the laparoscopic Roux-en-Y bypass; 43645 describes bypass with small-intestine reconstruction intended to limit absorption.
43846Gastric bypassShort-limb Roux-en-Y
43846 describes the open Roux-en-Y approach. Choose 43644 when the documented operation is performed laparoscopically.
43775Sleeve gastrectomyLaparoscopic approach
43775 is a laparoscopic sleeve procedure that removes part of the stomach; 43644 creates a pouch and connects it to the small intestine.

Codes related to 43644

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

Codes related to 43644
CodeHow it relatesNational office range
Same family
43645Gastric bypass, small-intestine reconstructionLaparoscopic bypass with additional small-intestine reconstruction to limit absorption.No office rate
Used instead
43846Gastric bypass, short-limb Roux-en-YOpen Roux-en-Y gastric bypass option for the same broad bariatric treatment need.No office rate
43847Bariatric surgery, small-intestine reconstructionOpen bypass with small-intestine reconstruction to limit absorption.No office rate
43775Sleeve gastrectomy, laparoscopic approachLaparoscopic sleeve gastrectomy is a different bariatric operation.No office rate

43644 billing questions

How does 43644 differ from 43645?

43644 describes a laparoscopic Roux-en-Y gastric bypass. 43645 is for a laparoscopic bypass that includes small-intestine reconstruction to limit absorption.

Can the pouch creation and intestinal connections be billed separately?

They are steps of the completed bypass reported under 43644, not separate reports of the same operation.

Does modifier 50 apply?

No. This is a single digestive-tract reconstruction, not surgery on paired anatomy.

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 reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery 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
RVUs for 43644PPRRVU2026_Oct_nonQPP.csv, line 5,275 (RVU26D)

Open CMS sourceHow we calculate rates

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