CPT code 43845: Duodenal switch, pylorus-preserving reconstruction2026 Medicare rate & RVUs

Medicare pays $1,827.03 for 43845 nationally in a facility.

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

What 43845 covers

This operation combines removal of part of the stomach with intestinal rerouting while preserving the pylorus. The surgeon connects the duodenum to the ileum and creates a second intestinal connection, changing how food and digestive secretions travel through the bowel. It is performed by a bariatric or gastrointestinal surgeon, typically in a hospital operating room, as a weight-loss procedure for a patient with severe obesity.

Choose this code when the operative report supports the pylorus-preserving duodenal-switch anatomy, including the partial gastrectomy and both intestinal connections; the label “bariatric surgery” alone is not enough. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this single reconstructive operation. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment 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 43845 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

43845 rates by state

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

How the 43845 rate is calculated

Each of 43845’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.

Payment rules and modifiers for 43845

43845 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

43845 compared with similar codes

How to choose

43846Gastric bypassShort-limb Roux-en-Y

Use 43845 for the pylorus-preserving duodenal switch with duodenoileal and ileoileal connections. Use 43846 for the short-limb Roux-en-Y gastric bypass configuration.

43847Bariatric surgerySmall-intestine reconstruction

Code 43847 describes gastric restriction with intestinal reconstruction to limit absorption, but not the specific pylorus-preserving duodenal-switch anatomy reported with 43845.

43843Gastric restrictionOther than vertical-banded gastroplasty

Code 43843 represents another restrictive gastric procedure, rather than the partial gastrectomy and two intestinal connections that define the duodenal switch.

Codes related to 43845

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

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