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CPT code 43842: Gastric restriction, vertical banded2026 Medicare rate & RVUs

Vertical banded gastroplasty forms a small stomach pouch with a reinforced outlet and is reported for this specific restrictive bariatric operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 43842

Gastric restriction, vertical banded

Office or facility?

Work RVUs
20.5
Total RVUs
30.49
Global days
090

National rate · 2026

—

Not priced in the facility setting.

See every locality for 43842 →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 43842 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 43842 covers

Vertical banded gastroplasty is a restrictive bariatric operation that forms a small upper stomach pouch using a vertical staple line and reinforces the outlet with a band. The smaller pouch limits the amount of food the stomach can hold. A surgeon performs the operation as weight-loss surgery. Its banded outlet and vertical staple line distinguish it from gastric bypass and from other restrictive stomach operations that use a different technique.

The physician fee schedule status is N, indicating Medicare does not cover this service. Report 43842 when the operation performed is vertical banded gastroplasty, rather than another restrictive technique or a revision of prior bariatric surgery. The operative report should identify the vertical staple-line pouch and band-reinforced outlet to support selection of this code.

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 43842 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

43842 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

43842 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
43842 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 43842 rate is calculated

Each of 43842’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 · 43842

RVUs × geographic indexes × conversion factor

Office or facility?

Work20.50

20.50 RVUs× 1.000 GPCI

Practice expense7.80

7.80 RVUs× 1.000 GPCI

Malpractice2.19

2.19 RVUs× 1.000 GPCI

Adjusted RVUs

30.4900

Conversion factor

$33.4009

Medicare rate

$1,018.39

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

Payment rules and modifiers for 43842

43842 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43842

Gastric restriction, vertical banded

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures9The concept doesn’t apply.
Bilateral (modifier 50)9The concept doesn’t apply.
Assistant at surgery (80/81/82/AS)9The concept doesn’t apply.
Co-surgeons (62)9The concept doesn’t apply.
Team surgery (66)9The concept doesn’t apply.
Professional/technical9The concept doesn’t apply.
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 · 43842

Gastric restriction, vertical banded

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

43842 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 43842

    Gastric restriction, vertical banded20.5 wRVU

    Not priced

  • 43843

    Gastric restriction, other than vertical-banded gastroplasty20.68 wRVU

    Not priced

  • 43846

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

    Not priced

  • 43889

    Sleeve gastroplasty, transoral endoscopic12.56 wRVU

    Not priced

How to choose

43843Gastric restrictionOther than vertical-banded gastroplasty
Use 43842 for vertical banded gastroplasty. Code 43843 describes a restrictive gastric procedure performed by another technique.
43846Gastric bypassShort-limb Roux-en-Y
Use 43842 for vertical banded gastroplasty. Code 43846 describes gastric bypass with Roux-en-Y reconstruction.
43889Sleeve gastroplastyTransoral endoscopic
Code 43889 describes transoral endoscopic sleeve gastroplasty; code 43842 describes vertical banded gastroplasty.

Codes related to 43842

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

Codes related to 43842
CodeHow it relatesNational office range
Same family
43843Gastric restriction, other than vertical-banded gastroplastyA gastric restrictive operation using a technique other than vertical banding.No office rate
Used instead
43846Gastric bypass, short-limb Roux-en-YGastric bypass with Roux-en-Y reconstruction is a different bariatric operation.No office rate
43845Duodenal switch, pylorus-preserving reconstructionGastroplasty with duodenal switch is a different bariatric surgical approach.No office rate
43889Sleeve gastroplasty, transoral endoscopicEndoscopic sleeve gastroplasty uses a transoral endoscopic approach.No office rate

43842 billing questions

How does this differ from code 43843?

Code 43842 identifies vertical banded gastroplasty. Code 43843 describes a gastric restrictive procedure using another technique.

How does this differ from code 43846?

Code 43842 describes a banded restrictive stomach operation. Code 43846 describes gastric bypass with Roux-en-Y reconstruction.

What operative details support selecting 43842?

The operative report should support a small upper stomach pouch formed with a vertical staple line and an outlet reinforced by a band.

How does Medicare treat this code?

The physician fee schedule status is N, indicating Medicare does not cover this service.

How does this differ from code 43889?

Code 43842 describes vertical banded gastroplasty. Code 43889 describes transoral endoscopic sleeve gastroplasty.

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

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