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Billing code 43501: Gastric repairMedicare rate & RVUs

Reports open stomach access with suture repair of a perforated ulcer, typically during surgery for an acute gastric perforation.

CMS RVU26DEffective Oct 1, 2026109 payment localities98 Medicare services in 2024

Medicare pays $1,268.57 for 43501 nationally in a facility.

Medicare rate · 43501

Gastric repair

Swap in your local Medicare rate.

Work RVUs
22.04
Total RVUs
37.98
Global days
090

National rate · 2026

$1,268.57

Facility setting, before claim adjustments.

See every locality for 43501 → · 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 43501 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 43501 covers

This operation involves opening the stomach and suturing a perforated ulcer. A surgeon typically performs it in an operating room when a gastric ulcer has perforated and requires operative repair. The operative report should establish the perforation and document the stomach opening and suture repair; the approach and exact work performed help distinguish this service from other gastric procedures.

Report the code for the ulcer repair, not as a separate charge for the stomach incision used to perform it. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be considered; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this stomach 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 43501 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

43501 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,141.84
Alaska*Unavailable$1,571.16
ArizonaUnavailable$1,230.06
ArkansasUnavailable$1,126.51
AtlantaUnavailable$1,315.32
AustinUnavailable$1,267.43
BakersfieldUnavailable$1,238.83
Baltimore/Surr. CntysUnavailable$1,351.15
BeaumontUnavailable$1,224.35
BrazoriaUnavailable$1,228.58

43501 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
43501 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 43501 rate is calculated

Each of 43501’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 · 43501

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 22.04Practice expense 10.11Malpractice 5.83

37.9800 adjusted RVUs×$33.4009 conversion factor=$1,268.57

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

Payment rules and modifiers for 43501

43501 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43501

Gastric repair

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 · 43501

Gastric repair

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

43501 without 51 · national facility

$1,268.57

Gastric repair

43501-51 · Second procedure: 50%

$634.29

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

43501 compared with similar codes

Compare codes

43501 vs 43500 vs 43502 vs 43840: national Medicare rates

Swap in your local Medicare rate.

  • 43501
    Gastric repair · 22.04 wRVU
    —
  • 43500
    Gastrotomy · 12.47 wRVU
    —
  • 43502
    Gastric repair · 25.05 wRVU
    —
  • 43840
    Ulcer repair · 22.26 wRVU
    —

How to choose

43500Gastrotomy
43500 describes gastrotomy for exploration or foreign body removal. Choose 43501 when the service includes suture repair of a perforated ulcer.
43502Gastric repair
43502 is for gastrotomy with drainage of an abscess or cyst; 43501 is for suture repair of a perforated ulcer.
43840Ulcer repair
43840 describes gastrorrhaphy for a perforated duodenal or gastric ulcer, wound, or injury. Select based on the operation documented, distinguishing that repair from the gastrotomy service in 43501.

Codes related to 43501

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

Codes related to 43501
CodeHow it relatesNational office range
Same family
43500GastrotomyGastrotomy for exploration or foreign body removal, rather than suture repair of a perforated ulcer.No office rate
43502Gastric repairA related gastrotomy service for drainage of an abscess or cyst.No office rate
Used instead
43840Ulcer repairConsider when the documented service is gastrorrhaphy for a perforated ulcer, wound, or injury.No office rate

43501 billing questions

When is this code different from 43500?

Use 43501 when the operative service includes suture repair of a perforated ulcer. Code 43500 describes a gastrotomy for exploration or foreign body removal.

Is the stomach incision separately reportable?

The gastrotomy is the access used for the repair described by 43501. Do not report that access incision as a separate service.

Should modifier 50 be appended?

No. A stomach repair is not a bilateral service, so modifier 50 is inappropriate.

How does the 90-day global period affect follow-up?

The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical episode.

Can an assistant or co-surgeon be reported?

CMS permits assistant-at-surgery payment consideration. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What documentation supports 43501?

Document the perforated gastric ulcer and the operative stomach opening and suture repair. The operative details should support this service rather than exploration, drainage, or another type of gastric procedure.

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 43501PPRRVU2026_Oct_nonQPP.csv, line 5,257 (RVU26D)

Open CMS sourceHow we calculate rates

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