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CPT code 43631: Partial gastrectomy2026 Medicare rate & RVUs

Open distal partial gastrectomy with reconnection of the remaining stomach to the duodenum, reported when resection and gastroduodenostomy are performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities398 Medicare services in 2024

Medicare pays $1,355.74 for 43631 nationally in a facility.

Medicare rate · 43631

Partial gastrectomy

Work RVUs
23.9
Total RVUs
40.59
Global days
090

National rate · 2026

$1,355.74

Facility setting, before claim adjustments.

See every locality for 43631 →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 43631 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 43631 covers

This code describes an open operation removing the distal portion of the stomach and reconnecting the gastric remnant directly to the duodenum. General surgeons and surgical oncologists may perform it for a distal gastric tumor or other disease requiring removal of that portion of the stomach. The reconstruction is commonly called a Billroth I. It is distinct from a more limited excision of a stomach lesion and from removal of the entire stomach.

Report the code when the operative note supports distal partial resection and a gastroduodenostomy. Document the portion removed and the reconstruction performed; a different reconstruction may point to another partial-gastrectomy code. The 90-day global 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 a 50% 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 stomach operation.

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 43631 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

43631 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,222.69
Alaska*Unavailable$1,685.71
ArizonaUnavailable$1,315.29
ArkansasUnavailable$1,206.59
AtlantaUnavailable$1,405.00
AustinUnavailable$1,354.40
BakersfieldUnavailable$1,324.55
Baltimore/Surr. CntysUnavailable$1,442.84
BeaumontUnavailable$1,309.47
BrazoriaUnavailable$1,313.84

43631 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
43631 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 43631 rate is calculated

Each of 43631’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 · 43631

RVUs × geographic indexes × conversion factor

Work23.90

23.90 RVUs× 1.000 GPCI

Practice expense10.55

10.55 RVUs× 1.000 GPCI

Malpractice6.14

6.14 RVUs× 1.000 GPCI

Adjusted RVUs

40.5900

Conversion factor

$33.4009

Medicare rate

$1,355.74

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

Payment rules and modifiers for 43631

43631 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43631

Partial gastrectomy

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 · 43631

Partial gastrectomy

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

43631 without 51 · national facility

$1,355.74

Partial gastrectomy

43631-51 · Second procedure: 50%

$677.87

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

43631 compared with similar codes

Compare codes · National

4 codes, side by side

  • 43631

    Partial gastrectomy23.9 wRVU

    Not priced

  • 43632

    Partial gastrectomy34.26 wRVU

    Not priced

  • 43633

    Partial gastrectomy32.31 wRVU

    Not priced

  • 43620

    Total gastrectomy33.19 wRVU

    Not priced

How to choose

43632Partial gastrectomy
Choose 43632 when the gastric remnant is connected to the jejunum. This code describes direct reconnection to the duodenum.
43633Partial gastrectomy
Choose 43633 for distal partial gastrectomy with Roux-en-Y reconstruction; this code is for gastroduodenostomy.
43620Total gastrectomy
43620 represents total gastrectomy. This code is for removing only the distal portion of the stomach and reconnecting the remnant to the duodenum.

Codes related to 43631

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

Codes related to 43631
CodeHow it relatesNational office range
Same family
43632Partial gastrectomyDistal partial gastrectomy with reconstruction to the jejunum.No office rate
43633Partial gastrectomyDistal partial gastrectomy with Roux-en-Y reconstruction.No office rate
43634Partial gastrectomyPartial gastrectomy code for a different gastric location and reconstruction.No office rate
Used instead
43620Total gastrectomyRemoval of the entire stomach rather than a distal portion.No office rate

43631 billing questions

How is this code distinguished from 43632?

This code describes reconnection of the gastric remnant to the duodenum. Code 43632 is for a distal partial gastrectomy reconstructed to the jejunum.

When would 43633 be selected instead?

Use 43633 when the distal partial gastrectomy is reconstructed with a Roux-en-Y configuration rather than a direct connection to the duodenum.

Can a separate lesion excision be reported for the removed stomach?

The gastric resection is integral to this operation. Do not separately report a lesion excision for tissue removed as part of the gastrectomy.

What operative details support reporting this code?

The operative report should establish that the resection was partial and distal, and that the gastric remnant was connected to the duodenum.

How does the 90-day global affect postoperative billing?

The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgical payment.

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 43631PPRRVU2026_Oct_nonQPP.csv, line 5,268 (RVU26D)

Open CMS sourceHow we calculate rates

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