CPT code 48146: Pancreatectomy, distal subtotal with pancreaticojejunostomy2026 Medicare rate & RVUs in Missouri
Report this code for distal subtotal removal of the pancreas when the surgeon reconnects the remaining pancreatic tissue to the jejunum.
CMS doesn’t publish an office rate for 48146 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 48146 covers
The surgeon removes a substantial portion of the distal pancreas, generally the body and tail, and connects the remaining pancreatic tissue to the jejunum to drain pancreatic secretions. Splenectomy may be performed as part of the operation. This major abdominal procedure is typically performed by a surgeon in an operating room, often for pancreatic disease requiring more than a limited excision.
Select this code when the operative report supports a distal subtotal resection and pancreaticojejunostomy; the reconstruction is part of the coded service. Document the extent and location of the resection, the pancreatic remnant, and the anastomosis. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 48146 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 | $1,730.99 |
| Metropolitan St. Louis, MO | Unavailable | $1,744.22 |
| Rest of Missouri | Unavailable | $1,691.33 |
How the 48146 rate is calculated
Each of 48146’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 · 48146
RVUs × geographic indexes × conversion factor
Work29.84
29.84 RVUs× 1.000 GPCI
Practice expense15.11
15.11 RVUs× 1.000 GPCI
Malpractice7.98
7.98 RVUs× 1.000 GPCI
Adjusted RVUs
52.9300
Conversion factor
$33.4009
Medicare rate
$1,767.91
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 48146
48146 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 48146
Pancreatectomy, distal subtotal with pancreaticojejunostomy
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| 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 · 48146
Pancreatectomy, distal subtotal with pancreaticojejunostomy
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
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
48146 without 51 · national facility
$1,767.91
Pancreatectomy, distal subtotal with pancreaticojejunostomy
48146-51 · Second procedure: 50%
$883.96
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%).
48146 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 48145PancreatectomyDistal resection with jejunal anastomosis
- Use 48146 when pancreaticojejunostomy is performed with the distal subtotal resection; 48145 describes the corresponding operation without it.
- 48140Pancreas resectionDistal, without pancreaticojejunostomy
- 48140 describes a different distal partial pancreatectomy service. Use 48146 when the documented operation is distal subtotal resection with pancreaticojejunostomy.
- 48150Whipple procedureProximal resection with duodenectomy
- 48150 is for a proximal subtotal pancreatic resection, while 48146 is for distal subtotal resection with pancreaticojejunostomy.
48146 billing questions
How does this differ from 48145?
Both describe distal subtotal pancreatectomy. Choose 48146 when the operation includes pancreaticojejunostomy; 48145 is the corresponding option without that reconstruction.
Is the pancreaticojejunostomy separately reported?
It is included in this service. The operative documentation should establish that the surgeon connected the pancreatic remnant to the jejunum.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this pancreatic operation.
What documentation supports this code?
The operative report should identify the distal subtotal extent of resection and describe the pancreaticojejunostomy. It should also clarify whether splenectomy was performed.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. 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
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