CPT code 43653: Gastrostomy, laparoscopic approach2026 Medicare rate & RVUs

Medicare pays $565.14 for 43653 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 43653 covers

The surgeon uses laparoscopic access to bring the stomach to the abdominal wall and create a gastrostomy opening for a feeding tube, without forming a separate gastric tube or conduit. This approach may be selected when a patient needs long-term enteral access and the surgeon performs the placement in the operating room. General and other surgeons with appropriate training commonly perform the procedure in a hospital facility.

Report 43653 when the operative documentation supports laparoscopic creation of the gastrostomy; distinguish it from access placed endoscopically, radiologically, or through an open incision. Documentation should identify the approach, the stomach-to-abdominal-wall opening, and the tube or access established. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment may be available; 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 43653 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

43653 rates by state

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

How the 43653 rate is calculated

Each of 43653’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 43653

43653 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

43653 compared with similar codes

How to choose

43830GastrostomyOpen, no gastric tube construction

Use 43653 for laparoscopic creation of the gastrostomy; 43830 describes the open approach.

49440Gastrostomy placementPercutaneous, image-guided

Use 49440 for percutaneous gastrostomy placement under radiologic guidance, not a surgeon's laparoscopic procedure.

43246PEG placementEndoscopic guidance

Use 43246 when the gastrostomy tube is placed endoscopically; 43653 requires a laparoscopic surgical approach.

43659Laparoscopic stomach procedureUnlisted procedure

43653 specifically describes laparoscopic gastrostomy. 43659 is for a laparoscopic stomach procedure without a more specific code.

Codes related to 43653

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