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CPT code 47721: Combined bypass, gallbladder and stomach2026 Medicare rate & RVUs

A combined bypass connecting the gallbladder and stomach to intestine, reported when both anastomoses are created during the same operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,275.91 for 47721 nationally in a facility.

Medicare rate · 47721

Combined bypass, gallbladder and stomach

Office or facility?

Work RVUs
21.44
Total RVUs
38.20
Global days
090

National rate · 2026

$1,275.91

Facility setting, before claim adjustments.

See every locality for 47721 →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 47721 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 47721 covers

This operation creates two intestinal connections: one from the gallbladder to the bowel to divert bile, and another from the stomach to the bowel to bypass an obstruction. It may be used in abdominal surgery when both biliary drainage and passage of stomach contents need surgical bypass, such as in selected patients with advanced pancreatic or periampullary disease. The surgeon’s operative report should establish that both connections were performed and identify the anatomy used.

Report the combined service when the operation includes both the gallbladder-to-bowel and stomach-to-bowel anastomoses. The major-surgery 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 the others at 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires 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 47721 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

47721 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,146.80
AlaskaUnavailable$1,571.99
ArizonaUnavailable$1,236.93
ArkansasUnavailable$1,131.15
Atlanta, GAUnavailable$1,322.43
Austin, TXUnavailable$1,276.90
Bakersfield, CAUnavailable$1,250.06
Baltimore area, MDUnavailable$1,359.63
Beaumont, TXUnavailable$1,229.17
Brazoria, TXUnavailable$1,236.22

47721 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
47721 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 47721 rate is calculated

Each of 47721’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 · 47721

RVUs × geographic indexes × conversion factor

Office or facility?

Work21.44

21.44 RVUs× 1.000 GPCI

Practice expense11.03

11.03 RVUs× 1.000 GPCI

Malpractice5.73

5.73 RVUs× 1.000 GPCI

Adjusted RVUs

38.2000

Conversion factor

$33.4009

Medicare rate

$1,275.91

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

Payment rules and modifiers for 47721

47721 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 47721

Combined bypass, gallbladder and stomach

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 · 47721

Combined bypass, gallbladder and stomach

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

47721 without 51 · national facility

$1,275.91

Combined bypass, gallbladder and stomach

47721-51 · Second procedure: 50%

$637.96

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

47721 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 47721

    Combined bypass, gallbladder and stomach21.44 wRVU

    Not priced

  • 47720

    Biliary bypass, gallbladder to bowel17.88 wRVU

    Not priced

  • 47740

    Biliary bypass, gallbladder to intestine20.7 wRVU

    Not priced

  • 47760

    Biliary bypass, choledochoenterostomy37.36 wRVU

    Not priced

How to choose

47720Biliary bypassGallbladder to bowel
47720 describes a gallbladder-to-bowel bypass without the combined stomach-to-bowel connection. Choose 47721 when both anastomoses are performed.
47740Biliary bypassGallbladder to intestine
47740 is another gallbladder-to-bowel bypass code. Select based on the specific operation documented, not simply because the patient has biliary obstruction.
47760Biliary bypassCholedochoenterostomy
47760 connects the bile duct to bowel; this code includes a gallbladder-to-bowel connection together with a stomach-to-bowel bypass.

Codes related to 47721

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

Codes related to 47721
CodeHow it relatesNational office range
Same family
47720Biliary bypass, gallbladder to bowelGallbladder-to-bowel bypass without the combined stomach-to-bowel connection.No office rate
47740Biliary bypass, gallbladder to intestineRelated gallbladder-to-bowel bypass code; distinguish by the operative service performed.No office rate
47741Biliary bypass, gallbladder to bowelRelated gallbladder-to-bowel bypass code; distinguish by the operative service performed.No office rate
Used instead
47760Biliary bypass, choledochoenterostomyCreates a bowel connection from the bile duct rather than the gallbladder.No office rate

47721 billing questions

When is this code preferable to 47720?

Use this code when the operation includes both a gallbladder-to-bowel connection and a stomach-to-bowel connection. Code 47720 represents a gallbladder-to-bowel bypass without that combined gastric bypass service.

Can the gastroenterostomy be reported separately?

This code represents the combined operation, including both connections. The operative report should document each anastomosis rather than describing only a biliary bypass.

Should modifier 50 be appended?

No. The anatomy and service represented by this code make bilateral reporting with modifier 50 inappropriate.

What postoperative care is included?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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 47721PPRRVU2026_Oct_nonQPP.csv, line 5,719 (RVU26D)

Open CMS sourceHow we calculate rates

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