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Billing code 43605: Stomach biopsyMedicare rate & RVUs

An open abdominal gastric biopsy obtains tissue for diagnosis when the surgeon samples the stomach during laparotomy rather than using a peroral approach.

CMS RVU26DEffective Oct 1, 2026109 payment localities110 Medicare services in 2024

Medicare pays $800.62 for 43605 nationally in a facility.

Medicare rate · 43605

Stomach biopsy

Swap in your local Medicare rate.

Work RVUs
13.38
Total RVUs
23.97
Global days
090

National rate · 2026

$800.62

Facility setting, before claim adjustments.

See every locality for 43605 → · 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 43605 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 43605 covers

Code 43605 represents diagnostic tissue sampling of the stomach through an open abdominal incision. The surgeon exposes the stomach during laparotomy and removes a specimen for histologic evaluation, such as when an abnormal area requires tissue diagnosis and open access is the approach used. This is an operative biopsy, not an excision intended to remove a gastric lesion as treatment. General or gastrointestinal surgeons typically perform the service in an operating room.

Report the code when the operative record supports an open approach and gastric tissue sampling. Document the indication, sampled site, findings, and specimen submitted. CMS assigns a 90-day global period, including 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 reduced to 50%. Assistant-at-surgery payment may be made; 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 43605 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

43605 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$719.46
Alaska*Unavailable$985.60
ArizonaUnavailable$776.14
ArkansasUnavailable$709.61
AtlantaUnavailable$829.74
AustinUnavailable$801.46
BakersfieldUnavailable$784.83
Baltimore/Surr. CntysUnavailable$853.20
BeaumontUnavailable$771.06
BrazoriaUnavailable$775.78

43605 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
43605 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 43605 rate is calculated

Each of 43605’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 · 43605

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.38Practice expense 7.01Malpractice 3.58

23.9700 adjusted RVUs×$33.4009 conversion factor=$800.62

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

Payment rules and modifiers for 43605

43605 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43605

Stomach biopsy

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 · 43605

Stomach biopsy

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

43605 without 51 · national facility

$800.62

Stomach biopsy

43605-51 · Second procedure: 50%

$400.31

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

43605 compared with similar codes

Compare codes

43605 vs 43610 vs 88305: national Medicare rates

Swap in your local Medicare rate.

  • 43605
    Stomach biopsy · 13.38 wRVU
    —
  • 43610
    Gastric lesion excision · 15.93 wRVU
    —
  • 88305
    Tissue pathology exam · 0.73 wRVU
    $70.14

How to choose

43610Gastric lesion excision
43605 represents tissue sampling for diagnosis. Choose 43610 when the service is excision of a stomach lesion rather than biopsy alone.
88305Tissue pathology exam
88305 represents the pathology examination of a specimen. Code 43605 represents the surgeon’s operative procurement of gastric tissue.

Codes related to 43605

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

Codes related to 43605
CodeHow it relatesNational office range
Used instead
43610Gastric lesion excisionExcision removes a stomach lesion rather than obtaining a diagnostic biopsy sample.No office rate
Often billed with
88305Tissue pathology examA pathologist may separately report the histologic examination of the gastric specimen.$63.46–$92.44

43605 billing questions

How does 43605 differ from 43600?

43605 is for gastric tissue sampling through an open abdominal approach. Code 43600 describes biopsy by mouth.

When is 43610 a better choice?

Use 43605 for diagnostic tissue sampling. Code 43610 is for excision of a stomach lesion rather than a biopsy alone.

What documentation supports 43605?

The operative report should establish the open approach, the reason for sampling, the stomach site sampled, and the tissue obtained.

Are related postoperative visits included?

Yes. 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 paid?

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

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 43605PPRRVU2026_Oct_nonQPP.csv, line 5,262 (RVU26D)

Open CMS sourceHow we calculate rates

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