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Billing code 43500: GastrotomyMedicare rate & RVUs

Report this service when a surgeon opens the stomach during an operation to inspect it or obtain one or more gastric biopsies.

CMS RVU26DEffective Oct 1, 2026109 payment localities144 Medicare services in 2024

Medicare pays $751.85 for 43500 nationally in a facility.

Medicare rate · 43500

Gastrotomy

Swap in your local Medicare rate.

Work RVUs
12.47
Total RVUs
22.51
Global days
090

National rate · 2026

$751.85

Facility setting, before claim adjustments.

See every locality for 43500 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 43500 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 43500 covers

A surgeon makes an operative opening in the stomach to examine its interior or take biopsy tissue. General surgeons typically perform this procedure in a hospital operating room as part of abdominal surgery when direct access to the stomach is needed; it is not an endoscopic biopsy. The code covers exploration or one or more biopsies through the gastrotomy.

Choose the code when the operative record documents the gastric incision and its exploratory or biopsy purpose. 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 multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this procedure.

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 43500 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

43500 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$676.39
Alaska*Unavailable$926.11
ArizonaUnavailable$729.19
ArkansasUnavailable$667.23
AtlantaUnavailable$778.55
AustinUnavailable$753.47
BakersfieldUnavailable$739.10
Baltimore/Surr. CntysUnavailable$800.80
BeaumontUnavailable$723.74
BrazoriaUnavailable$729.26

43500 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
43500 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 43500 rate is calculated

Each of 43500’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 · 43500

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.47Practice expense 6.79Malpractice 3.25

22.5100 adjusted RVUs×$33.4009 conversion factor=$751.85

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 43500

43500 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43500

Gastrotomy

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 · 43500

Gastrotomy

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

43500 without 51 · national facility

$751.85

Gastrotomy

43500-51 · Second procedure: 50%

$375.93

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

43500 compared with similar codes

Compare codes

43500 vs 43501 vs 43502 vs 43510 vs 43520: national Medicare rates

Swap in your local Medicare rate.

  • 43500
    Gastrotomy · 12.47 wRVU
    —
  • 43501
    Gastric repair · 22.04 wRVU
    —
  • 43502
    Gastric repair · 25.05 wRVU
    —
  • 43510
    Gastrotomy · 14.76 wRVU
    —
  • 43520
    Pyloromyotomy · 11.01 wRVU
    —

How to choose

43501Gastric repair
Use 43500 for gastric exploration or biopsy through an operative opening. Choose 43501 when the documented procedure is gastric repair.
43502Gastric repair
43500 describes opening the stomach for inspection or biopsy; 43502 is a gastric repair service.
43510Gastrotomy
Both involve an operative gastric opening, but 43500 is selected for exploration or biopsy; use 43510 when its distinct procedure is performed.
43520Pyloromyotomy
43520 involves incision of the pyloric muscle, rather than opening the stomach for exploration or biopsy.

Codes related to 43500

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

Codes related to 43500
CodeHow it relatesNational office range
Same family
43501Gastric repairA nearby gastric procedure for repair rather than exploration or biopsy.No office rate
43502Gastric repairAnother gastric repair code; distinguish the operative purpose from exploration or biopsy.No office rate
43510GastrotomyA related gastric-opening procedure with a different operative purpose.No office rate

43500 billing questions

When should 43500 be reported instead of a gastric repair code?

Report 43500 when the stomach is opened for exploration or biopsy. A procedure whose purpose is to repair a gastric defect or lesion belongs to the applicable repair code instead.

Does 43500 cover multiple gastric biopsies?

Yes. The service includes one or more biopsies taken through the gastrotomy; do not report additional units of 43500 just for additional biopsy samples.

Can modifier 50 be used for a gastrotomy?

No. Modifier 50 is inappropriate for this procedure.

How does the 90-day global period affect billing?

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

How are other procedures in the same session handled?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and 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 43500PPRRVU2026_Oct_nonQPP.csv, line 5,256 (RVU26D)

Open CMS sourceHow we calculate rates

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