FeeBase
Log inGet started
Menu

CPT code 43800: Pyloroplasty2026 Medicare rate & RVUs

Reports surgical enlargement of the pyloric outlet, commonly to improve gastric emptying when narrowing obstructs passage from the stomach.

CMS RVU26DEffective Oct 1, 2026109 payment localities209 Medicare services in 2024

Medicare pays $871.10 for 43800 nationally in a facility.

Medicare rate · 43800

Pyloroplasty

Office or facility?

Work RVUs
15.04
Total RVUs
26.08
Global days
090

National rate · 2026

$871.10

Facility setting, before claim adjustments.

See every locality for 43800 →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 43800 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 43800 covers

A surgeon enlarges the pyloric channel, the outlet between the stomach and duodenum, by surgically opening and reconstructing the area to improve passage of stomach contents. The procedure may be performed for gastric outlet narrowing, including narrowing associated with peptic ulcer disease, or as a drainage procedure during gastric surgery. It is typically performed in an operating room by a general or gastrointestinal surgeon.

Report 43800 when the operative work is pyloroplasty, rather than creation of a bypass or a stomach-to-duodenum connection. The operative report should identify the pylorus as the site and describe the incision and reconstruction that widen the outlet. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. Assistant-at-surgery payment may be made; 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 43800 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

43800 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$786.40
AlaskaUnavailable$1,082.03
ArizonaUnavailable$845.55
ArkansasUnavailable$776.13
Atlanta, GAUnavailable$901.61
Austin, TXUnavailable$872.00
Bakersfield, CAUnavailable$855.20
Baltimore area, MDUnavailable$926.54
Beaumont, TXUnavailable$840.28
Brazoria, TXUnavailable$845.44

43800 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
43800 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 43800 rate is calculated

Each of 43800’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 · 43800

RVUs × geographic indexes × conversion factor

Office or facility?

Work15.04

15.04 RVUs× 1.000 GPCI

Practice expense7.30

7.30 RVUs× 1.000 GPCI

Malpractice3.74

3.74 RVUs× 1.000 GPCI

Adjusted RVUs

26.0800

Conversion factor

$33.4009

Medicare rate

$871.10

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

Payment rules and modifiers for 43800

43800 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43800

Pyloroplasty

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 · 43800

Pyloroplasty

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

43800 without 51 · national facility

$871.10

Pyloroplasty

43800-51 · Second procedure: 50%

$435.55

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

43800 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43800

    Pyloroplasty15.04 wRVU

    Not priced

  • 43810

    Gastroduodenostomy, stomach to duodenum16.46 wRVU

    Not priced

  • 43820

    Gastrojejunostomy, without vagotomy21.97 wRVU

    Not priced

  • 43825

    Gastrojejunostomy, with vagotomy21.22 wRVU

    Not priced

How to choose

43810GastroduodenostomyStomach to duodenum
Choose 43800 for surgical widening of the pylorus. Choose 43810 when the surgeon creates a direct connection between the stomach and duodenum.
43820GastrojejunostomyWithout vagotomy
43800 enlarges the existing gastric outlet. 43820 creates a gastrojejunostomy, routing stomach contents to the jejunum.
43825GastrojejunostomyWith vagotomy
43825 describes a gastrojejunostomy performed with vagotomy. It is not the code for widening the pyloric outlet.

Codes related to 43800

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

Codes related to 43800
CodeHow it relatesNational office range
Used instead
43810Gastroduodenostomy, stomach to duodenumCreates a stomach-to-duodenum connection rather than widening the pyloric outlet.No office rate
43820Gastrojejunostomy, without vagotomyCreates a stomach-to-jejunum bypass without vagotomy instead of widening the pylorus.No office rate
43825Gastrojejunostomy, with vagotomyCreates a stomach-to-jejunum bypass with vagotomy rather than performing pyloroplasty.No office rate

43800 billing questions

How does pyloroplasty differ from gastroduodenostomy?

Pyloroplasty widens the existing pyloric outlet. Gastroduodenostomy creates a connection between the stomach and duodenum.

Is related postoperative care separately reported during the global period?

The 90-day global period includes related postoperative care and the day-before preoperative visit. Report a separate service only when the circumstances support separate reporting under applicable coding rules.

How is 43800 affected when another procedure is performed in the same session?

CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.

What documentation supports reporting pyloroplasty?

The operative report should identify work on the pylorus and describe how the outlet was surgically widened. Documentation of a bypass or a different reconstruction supports consideration of the code for that procedure instead.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted for this code.

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 43800PPRRVU2026_Oct_nonQPP.csv, line 5,298 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 43800 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 43800 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet