CPT code 43843: Gastric restriction, other than vertical-banded gastroplasty2026 Medicare rate & RVUs in Utah

Reports a gastric-restrictive operation for morbid obesity that limits stomach capacity without gastric bypass and is not vertical-banded gastroplasty.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Utah, Medicare pays $1,167.74 for 43843 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$1,167.74Hospital or facility

Check a contract rate as a % of Medicare · 43843 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 43843 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Utah
  2. What 43843 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 43843 covers

This code describes an operation for morbid obesity that reduces the stomach’s capacity to restrict food intake, without creating a gastric bypass and without using the vertical-banded gastroplasty technique. A bariatric or general surgeon typically performs the procedure in an operating room. The operative report should identify the procedure actually performed and the changes made to the stomach so the service can be distinguished from bypass, vertical-banded gastroplasty, and revision surgery.

Select this code from the operative technique, not simply from the patient’s obesity diagnosis or the intended weight-loss effect. Documentation should support the indication, anatomy treated, and work performed. 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 multiple-procedure reduction. Assistant-at-surgery and co-surgeon payment may be allowed; team surgery is not permitted under this code’s CMS rules.

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.

How Utah compares for 43843

Across 109 of 109 payment localities, the facility rate for 43843 runs from $1,064.72 in Wisconsin to $1,502.43 in Miami, FL. Utah pays $1,167.74. The RVUs are the same everywhere; the geographic indexes change the dollars.

43843 in Utah vs other payment areas
  1. Utah · this page$1,167.74
  2. Los Angeles, CA · California$1,233.27+$65.53
  3. Washington, DC area · District of Columbia$1,323.53+$155.79
  4. Miami, FL · Florida$1,502.43+$334.69
  5. Chicago, IL · Illinois$1,452.13+$284.39
  6. Manhattan, NY · New York$1,412.51+$244.77
  7. Alaska · Alaska$1,490.39+$322.65

Other areas in Utah first, then benchmark localities. Bars start at $0.

Every other payment area

43843 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$1,084.90
ArkansasArkansas—$1,070.19
ArizonaArizona—$1,169.58
Bakersfield, CACalifornia—$1,179.12
Chico, CACalifornia—$1,164.26
El Centro, CACalifornia—$1,165.18
Fresno, CACalifornia—$1,164.26
Hanford, CACalifornia—$1,164.26

43843 rates by state

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

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
43843 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

See 43843 in every payment locality

How the 43843 rate is calculated

Each of 43843’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 · 43843

RVUs × geographic indexes × conversion factor

Office or facility?

Work20.68

20.68 RVUs× 1.000 GPCI

Practice expense9.91

9.91 RVUs× 1.000 GPCI

Malpractice5.53

5.53 RVUs× 1.000 GPCI

Adjusted RVUs

36.1200

Conversion factor

$33.4009

Medicare rate

$1,206.44

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

The exact Utah inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,307

Code
43843
Physician work
20.68
Practice expense
9.91
Malpractice
5.53

GPCI2026.csv

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Facility calculation for 43843 in Utah
ComponentRVULocality factorAdjusted
Physician work20.68× 1.00020.6800
Practice expense9.91× 0.9409.3154
Malpractice5.53× 0.8984.9659
Total RVUs34.9613
Conversion factor× 33.4009

Facility rate, Utah$1167.74

Facility: (20.68 × 1 + 9.91 × 0.94 + 5.53 × 0.898) × $33.4009 = $1167.74

Open 43843 in the RVU calculator

Payment rules and modifiers for 43843

43843 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43843

Gastric restriction, other than vertical-banded gastroplasty

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)2Permitted.
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 · 43843

Gastric restriction, other than vertical-banded gastroplasty

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

43843 without 51 · national facility

$1,206.44

Gastric restriction, other than vertical-banded gastroplasty

43843-51 · Second procedure: 50%

$603.22

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

How 43843 has changed in Utah

43843 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$1,167.74RVU26D
2026-07-01Not available in this setting$1,167.74RVU26C
2026-04-01Not available in this setting$1,167.74RVU26B
2026-01-01Not available in this setting$1,167.74RVU26A
2025-10-01Not available in this setting$1,216.40RVU25D
2025-07-01Not available in this setting$1,216.40RVU25C
2025-04-01Not available in this setting$1,216.40RVU25B
2025-01-01Not available in this setting$1,216.40RVU25A
2024-10-01Not available in this setting$1,245.26RVU24D
2024-07-01Not available in this setting$1,245.26RVU24C
2024-04-01Not available in this setting$1,245.26RVU24B
2024-03-09Not available in this setting$1,245.26RVU24AR
2024-01-01Not available in this setting$1,224.93RVU24A
2023-10-01Not available in this setting$1,246.56RVU23D
2023-07-01Not available in this setting$1,246.56RVU23C
2023-04-01Not available in this setting$1,246.56RVU23B
2023-01-01Not available in this setting$1,246.56RVU23A
2022-10-01Not available in this setting$1,258.43RVU22D
2022-07-01Not available in this setting$1,258.43RVU22C
2022-04-01Not available in this setting$1,258.43RVU22B
2022-01-01Not available in this setting$1,258.43RVU22A
2021-10-01Not available in this setting$1,257.44RVU21D
2021-07-01Not available in this setting$1,257.44RVU21C
2021-04-01Not available in this setting$1,257.44RVU21B
2021-01-01Not available in this setting$1,257.44RVU21A
2020-10-01Not available in this setting$1,316.39RVU20D
2020-07-01Not available in this setting$1,316.39RVU20C
2020-04-01Not available in this setting$1,316.39RVU20B
2020-01-01Not available in this setting$1,316.39RVU20A
2019-10-01Not available in this setting$1,343.76RVU19D
2019-07-01Not available in this setting$1,343.76RVU19C
2019-04-01Not available in this setting$1,317.31RVU19B
2019-01-01Not available in this setting$1,317.31RVU19A
2018-10-01Not available in this setting$1,338.19RVU18D
2018-07-01Not available in this setting$1,338.19RVU18C
2018-04-01Not available in this setting$1,338.19RVU18B
2018-01-01Not available in this setting$1,338.19RVU18AR1
2017-10-01Not available in this setting$1,321.46RVU17D
2017-07-01Not available in this setting$1,321.46RVU17C
2017-04-01Not available in this setting$1,321.46RVU17B
2017-01-01Not available in this setting$1,321.46RVU17A
2016-10-01Not available in this setting$1,327.87RVU16D
2016-07-01Not available in this setting$1,327.87RVU16C
2016-04-01Not available in this setting$1,327.87RVU16B
2016-01-01Not available in this setting$1,327.87RVU16A
2015-10-01Not available in this setting$1,333.86RVU15D
2015-07-01Not available in this setting$1,333.86RVU15C
2015-04-01Not available in this setting$1,327.22RVU15B
2015-01-01Not available in this setting$1,327.22RVU15A
2014-10-01Not available in this setting$1,293.46RVU14D
2014-07-01Not available in this setting$1,293.46RVU14C
2014-04-01Not available in this setting$1,293.46RVU14B
2014-01-01Not available in this setting$1,293.46RVU14A
2013-10-01Not available in this setting$1,267.57RVU13D
2013-07-01Not available in this setting$1,267.57RVU13C
2013-04-01Not available in this setting$1,267.57RVU13B
2013-01-01Not available in this setting$1,267.57RVU13AR

Price 43843 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

43843 billing questions

How is this code distinguished from 43842?

43842 describes vertical-banded gastroplasty. Use 43843 for a qualifying gastric-restrictive operation other than that specific technique, without gastric bypass.

Can this code be used for a gastric bypass?

No. The service is a restrictive operation without gastric bypass. Choose a bypass code when the operative procedure includes the bypass reconstruction.

What documentation supports reporting 43843?

The operative report should describe the restrictive technique, the stomach anatomy altered, and the indication for surgery. It should make clear that the procedure was neither vertical-banded gastroplasty nor gastric bypass.

How does the 90-day global period affect postoperative billing?

The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the global surgical package.

Can an assistant or co-surgeon be reported?

CMS indicates that assistant-at-surgery payment may be made and that co-surgeons are permitted. Team surgery is not permitted under this code’s CMS rules.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

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 43843PPRRVU2026_Oct_nonQPP.csv, line 5,307 (RVU26D)
Geographic factors for UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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