CPT code 43831: Gastrostomy, neonatal, open approach2026 Medicare rate & RVUs in Massachusetts
Reports open surgical creation of gastric access in a neonate when enteral access is needed and the procedure is performed through an abdominal incision.
CMS doesn’t publish an office rate for 43831 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 43831 covers
A surgeon creates gastric access through an open abdominal operation in a neonate. The procedure may be chosen when an infant cannot take adequate nutrition by mouth and needs enteral access. Pediatric or general surgeons typically perform it in an operating room, often in an inpatient setting. The operative report should support the neonatal patient population, open approach, and creation of the gastrostomy.
Select this code for the neonatal open procedure rather than an endoscopic or image-guided placement. Document the operative method and any details that distinguish it from other open gastrostomy services. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate.
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 43831 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $650.41 |
| Rest of Massachusetts | Unavailable | $601.57 |
How the 43831 rate is calculated
Each of 43831’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 · 43831
RVUs × geographic indexes × conversion factor
Work8.28
8.28 RVUs× 1.000 GPCI
Practice expense7.45
7.45 RVUs× 1.000 GPCI
Malpractice2.20
2.20 RVUs× 1.000 GPCI
Adjusted RVUs
17.9300
Conversion factor
$33.4009
Medicare rate
$598.88
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43831
43831 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43831
Gastrostomy, neonatal, open 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 · 43831
Gastrostomy, neonatal, open 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
43831 without 51 · national facility
$598.88
Gastrostomy, neonatal, open approach
43831-51 · Second procedure: 50%
$299.44
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%).
43831 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43830GastrostomyOpen, no gastric tube construction
- Both describe open gastrostomy services, but this code is specifically for a neonate; 43830 lacks that neonatal designation.
- 43832Open gastrostomyWith gastric tube construction
- Code 43832 describes open gastrostomy with construction of a gastric tube. Use this code for the neonatal open service when that is the documented procedure.
- 43246PEG placementEndoscopic guidance
- Code 43246 is for endoscopic gastrostomy placement. This code describes an open operation in a neonate.
- 49440Gastrostomy placementPercutaneous, image-guided
- Code 49440 describes image-guided percutaneous gastrostomy placement; this code is for open neonatal surgery.
43831 billing questions
How does this differ from code 43830?
This code identifies an open gastrostomy in a neonate. Code 43830 is the open gastrostomy code without that neonatal designation.
How does this differ from code 43832?
Code 43832 describes an open gastrostomy involving construction of a gastric tube. Choose based on the documented procedure, including the neonatal designation for this code.
Can modifier 50 be used?
No. The CMS bilateral adjustment does not apply to this procedure, and 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.
What supports reporting an assistant or co-surgeon?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, while 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
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