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CPT code 43865: Anastomosis revision, with vagotomy2026 Medicare rate & RVUs

Revision of an existing gastrojejunal connection with vagotomy is reported when the surgeon revises the anastomosis and divides vagal nerves during the same operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,588.21 for 43865 nationally in a facility.

Medicare rate · 43865

Anastomosis revision, with vagotomy

Office or facility?

Work RVUs
28.32
Total RVUs
47.55
Global days
090

National rate · 2026

$1,588.21

Facility setting, before claim adjustments.

See every locality for 43865 →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 43865 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 43865 covers

This code describes an operation on an existing connection between the stomach and jejunum, with vagotomy performed as part of the revision. Surgeons may revise the connection to address problems such as narrowing or recurrent ulceration; the vagotomy reduces vagal stimulation of acid secretion. The procedure is typically performed by a general or upper gastrointestinal surgeon in a hospital operating room, including in patients with prior gastric surgery.

Report the code when the operative record supports both revision of the existing gastrojejunal anastomosis and vagotomy. A revision without vagotomy is distinguished by 43860, while construction of a new gastrojejunostomy is a different service. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery 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 43865 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

43865 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,429.80
AlaskaUnavailable$1,972.96
ArizonaUnavailable$1,539.73
ArkansasUnavailable$1,410.67
Atlanta, GAUnavailable$1,648.10
Austin, TXUnavailable$1,583.87
Bakersfield, CAUnavailable$1,544.71
Baltimore area, MDUnavailable$1,691.70
Beaumont, TXUnavailable$1,535.21
Brazoria, TXUnavailable$1,536.65

43865 rates by state

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

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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
43865 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 43865 rate is calculated

Each of 43865’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 · 43865

RVUs × geographic indexes × conversion factor

Office or facility?

Work28.32

28.32 RVUs× 1.000 GPCI

Practice expense11.66

11.66 RVUs× 1.000 GPCI

Malpractice7.57

7.57 RVUs× 1.000 GPCI

Adjusted RVUs

47.5500

Conversion factor

$33.4009

Medicare rate

$1,588.21

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

Payment rules and modifiers for 43865

43865 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43865

Anastomosis revision, with vagotomy

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)1Permitted with supporting documentation.
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 · 43865

Anastomosis revision, with vagotomy

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

43865 without 51 · national facility

$1,588.21

Anastomosis revision, with vagotomy

43865-51 · Second procedure: 50%

$794.11

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

43865 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 43865

    Anastomosis revision, with vagotomy28.32 wRVU

    Not priced

  • 43860

    Anastomosis revision, without vagotomy27.19 wRVU

    Not priced

  • 43825

    Gastrojejunostomy, with vagotomy21.22 wRVU

    Not priced

  • 43820

    Gastrojejunostomy, without vagotomy21.97 wRVU

    Not priced

  • 43848

    Bariatric revision, open approach31.93 wRVU

    Not priced

How to choose

43860Anastomosis revisionWithout vagotomy
Choose 43860 when the surgeon revises the existing gastrojejunal anastomosis without performing vagotomy; 43865 includes both services.
43825GastrojejunostomyWith vagotomy
43825 describes gastrojejunostomy with vagotomy, not revision of an existing gastrojejunal anastomosis.
43820GastrojejunostomyWithout vagotomy
43820 describes gastrojejunostomy without vagotomy; 43865 is for revision of an existing connection with vagotomy.
43848Bariatric revisionOpen approach
43848 is for revision of an open gastric restrictive procedure. Use 43865 when the operation revises the gastrojejunal anastomosis and includes vagotomy.

Codes related to 43865

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

Codes related to 43865
CodeHow it relatesNational office range
Same family
43860Anastomosis revision, without vagotomyRevision of a gastrojejunal anastomosis without vagotomy.No office rate
43825Gastrojejunostomy, with vagotomyGastrojejunostomy with vagotomy; describes creation rather than revision of an existing connection.No office rate
43820Gastrojejunostomy, without vagotomyGastrojejunostomy without vagotomy, rather than revision of an existing anastomosis.No office rate
Used instead
43848Bariatric revision, open approachFor revision of an open gastric restrictive procedure rather than gastrojejunal anastomosis revision with vagotomy.No office rate

43865 billing questions

How does 43865 differ from 43860?

43865 includes vagotomy along with revision of the existing gastrojejunal anastomosis. Use 43860 for the corresponding revision without vagotomy.

Does this code describe creation of a new gastrojejunostomy?

No. It describes revision of an existing gastrojejunal connection. Codes 43820 and 43825 describe gastrojejunostomy procedures rather than this revision service.

What documentation supports reporting 43865?

The operative report should identify the prior gastrojejunal anastomosis, the revision performed, and the vagotomy. Documentation of vagotomy alone does not support this code.

Can modifier 50 be used?

No. Bilateral adjustment does not apply to this procedure, and modifier 50 is inappropriate.

How are assistant and co-surgeon services handled?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

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 43865PPRRVU2026_Oct_nonQPP.csv, line 5,313 (RVU26D)

Open CMS sourceHow we calculate rates

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