CPT code 43653: Gastrostomy, laparoscopic approach2026 Medicare rate & RVUs in Guam
Report laparoscopic surgical gastrostomy when the surgeon establishes stomach-to-skin access, typically for enteral feeding, using a minimally invasive abdominal approach.
CMS doesn’t publish an office rate for 43653 in Guam.
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
On this page 9 sections
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.
43653 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $564.47 |
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.
How the rate is built · 43653
RVUs × geographic indexes × conversion factor
Work8.27
8.27 RVUs× 1.000 GPCI
Practice expense6.49
6.49 RVUs× 1.000 GPCI
Malpractice2.16
2.16 RVUs× 1.000 GPCI
Adjusted RVUs
16.9200
Conversion factor
$33.4009
Medicare rate
$565.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43653
43653 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43653
Gastrostomy, laparoscopic approach
| 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 · 43653
Gastrostomy, laparoscopic approach
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
43653 without 51 · national facility
$565.14
Gastrostomy, laparoscopic approach
43653-51 · Second procedure: 50%
$282.57
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%).
43653 compared with similar codes
Compare codes · National
5 codes, side by side
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.
43653 billing questions
How is 43653 different from an open gastrostomy?
43653 is for a laparoscopic approach. An open incision approach is reported with the applicable open gastrostomy code, such as 43830.
Can 43653 be reported for a radiologic or endoscopic tube placement?
No. Use 43653 when the surgeon creates the gastrostomy laparoscopically; radiologic and endoscopic approaches have distinct codes, including 49440 and 43246.
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 surgeon be paid for this procedure?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
Should modifier 50 be used for a gastrostomy?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
How does Medicare handle 43653 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple-procedure reduction.
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
Fee sheets · Coming soon
Put 43653 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist