CPT code 43842: Gastric restriction, vertical banded2026 Medicare rate & RVUs in Missouri
Vertical banded gastroplasty forms a small stomach pouch with a reinforced outlet and is reported for this specific restrictive bariatric operation.
CMS doesn’t publish an office rate for 43842 in Missouri.
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 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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | Unavailable |
| Metropolitan St. Louis, MO | Unavailable | Unavailable |
| Rest of Missouri | Unavailable | Unavailable |
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
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
| 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 | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 9 | The concept doesn’t apply. |
| 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 · 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.
Pre-op dayGlobal period
43842 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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