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Billing code 43843: Gastric restrictionMedicare rate & RVUs

Reports a gastric-restrictive operation for morbid obesity that limits stomach capacity without gastric bypass and is not vertical-banded gastroplasty.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,206.44 for 43843 nationally in a facility.

Medicare rate · 43843

Gastric restriction

Swap in your local Medicare rate.

Work RVUs
20.68
Total RVUs
36.12
Global days
090

National rate · 2026

$1,206.44

Facility setting, before claim adjustments.

See every locality for 43843 → · 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 43843 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 43843 covers

This code describes an operation for morbid obesity that reduces the stomach’s capacity to restrict food intake, without creating a gastric bypass and without using the vertical-banded gastroplasty technique. A bariatric or general surgeon typically performs the procedure in an operating room. The operative report should identify the procedure actually performed and the changes made to the stomach so the service can be distinguished from bypass, vertical-banded gastroplasty, and revision surgery.

Select this code from the operative technique, not simply from the patient’s obesity diagnosis or the intended weight-loss effect. Documentation should support the indication, anatomy treated, and work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 and co-surgeon payment may be allowed; team surgery is not permitted under this code’s CMS rules.

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 43843 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

43843 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,084.90
Alaska*Unavailable$1,490.39
ArizonaUnavailable$1,169.58
ArkansasUnavailable$1,070.19
AtlantaUnavailable$1,250.93
AustinUnavailable$1,205.96
BakersfieldUnavailable$1,179.12
Baltimore/Surr. CntysUnavailable$1,285.43
BeaumontUnavailable$1,163.54
BrazoriaUnavailable$1,168.35

43843 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
43843 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 43843 rate is calculated

Each of 43843’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 · 43843

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 20.68Practice expense 9.91Malpractice 5.53

36.1200 adjusted RVUs×$33.4009 conversion factor=$1,206.44

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

Payment rules and modifiers for 43843

43843 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43843

Gastric restriction

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)2Permitted.
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 · 43843

Gastric restriction

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

43843 without 51 · national facility

$1,206.44

Gastric restriction

43843-51 · Second procedure: 50%

$603.22

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

43843 compared with similar codes

Compare codes

43843 vs 43842 vs 43845 vs 43846 vs 43848: national Medicare rates

Swap in your local Medicare rate.

  • 43843
    Gastric restriction · 20.68 wRVU
    —
  • 43842
    · 20.5 wRVU
    —
  • 43845
    Duodenal switch · 32.47 wRVU
    —
  • 43846
    Gastric bypass · 26.72 wRVU
    —
  • 43848
    Bariatric revision · 31.93 wRVU
    —

How to choose

43842Gstr rstcv px v-banded gstp
43842 is specifically for vertical-banded gastroplasty. Code 43843 is for a gastric-restrictive operation other than that technique and without gastric bypass.
43845Duodenal switch
43845 describes a duodenal-switch operation. Use 43843 when the operation is restrictive without a gastric bypass or duodenal-switch reconstruction.
43846Gastric bypass
43846 includes gastric bypass with a short-limb Roux-en-Y reconstruction. Code 43843 describes restriction without a bypass.
43848Bariatric revision
43848 is for revision of a prior open gastric-restrictive procedure. Code 43843 describes the restrictive operation itself, rather than revision.

Codes related to 43843

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

Codes related to 43843
CodeHow it relatesNational office range
Same family
43842Gstr rstcv px v-banded gstpSibling code for vertical-banded gastroplasty, a distinct gastric-restrictive technique.No office rate
Used instead
43845Duodenal switchDescribes a duodenal-switch gastroplasty rather than this non-bypass restrictive procedure.No office rate
43846Gastric bypassDescribes gastric restriction with a short-limb Roux-en-Y bypass.No office rate
43848Bariatric revisionDescribes revision of a prior open gastric-restrictive procedure, not the initial operation.No office rate

43843 billing questions

How is this code distinguished from 43842?

43842 describes vertical-banded gastroplasty. Use 43843 for a qualifying gastric-restrictive operation other than that specific technique, without gastric bypass.

Can this code be used for a gastric bypass?

No. The service is a restrictive operation without gastric bypass. Choose a bypass code when the operative procedure includes the bypass reconstruction.

What documentation supports reporting 43843?

The operative report should describe the restrictive technique, the stomach anatomy altered, and the indication for surgery. It should make clear that the procedure was neither vertical-banded gastroplasty nor gastric bypass.

How does the 90-day global period affect postoperative billing?

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

Can an assistant or co-surgeon be reported?

CMS indicates that assistant-at-surgery payment may be made and that co-surgeons are permitted. Team surgery is not permitted under this code’s CMS rules.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

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 43843PPRRVU2026_Oct_nonQPP.csv, line 5,307 (RVU26D)

Open CMS sourceHow we calculate rates

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