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Billing code 43880: Fistula closureMedicare rate & RVUs

Reports operative closure of an abnormal connection between the stomach and colon, with payment subject to the major-surgery global period and applicable same-session reductions.

CMS RVU26DEffective Oct 1, 2026109 payment localities109 Medicare services in 2024

Medicare pays $1,496.69 for 43880 nationally in a facility.

Medicare rate · 43880

Fistula closure

Swap in your local Medicare rate.

Work RVUs
26.5
Total RVUs
44.81
Global days
090

National rate · 2026

$1,496.69

Facility setting, before claim adjustments.

See every locality for 43880 → · 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 43880 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 43880 covers

billing code 43880 describes surgery to close a gastrocolic fistula, an abnormal passage connecting the stomach and colon. A general or gastrointestinal surgeon typically performs the repair in an operating room. The operative record should identify the connection and document the work done to close it; a gastrostomy opening or a different gastric anastomosis is not this fistula.

Report the code for the fistula closure, supported by the operative findings and procedure details. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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 50% reduction. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this service.

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 43880 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

43880 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,347.07
Alaska*Unavailable$1,857.29
ArizonaUnavailable$1,450.98
ArkansasUnavailable$1,329.00
AtlantaUnavailable$1,552.95
AustinUnavailable$1,493.20
BakersfieldUnavailable$1,456.89
Baltimore/Surr. CntysUnavailable$1,594.34
BeaumontUnavailable$1,446.15
BrazoriaUnavailable$1,448.30

43880 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
43880 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 43880 rate is calculated

Each of 43880’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 · 43880

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 26.50Practice expense 11.22Malpractice 7.09

44.8100 adjusted RVUs×$33.4009 conversion factor=$1,496.69

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

Payment rules and modifiers for 43880

43880 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 43880

Fistula closure

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 · 43880

Fistula closure

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

43880 without 51 · national facility

$1,496.69

Fistula closure

43880-51 · Second procedure: 50%

$748.35

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

43880 compared with similar codes

Compare codes

43880 vs 43870 vs 43810 vs 43820: national Medicare rates

Swap in your local Medicare rate.

  • 43880
    Fistula closure · 26.5 wRVU
    —
  • 43870
    Gastrostomy closure · 11.15 wRVU
    —
  • 43810
    Gastroduodenostomy · 16.46 wRVU
    —
  • 43820
    Gastrojejunostomy · 21.97 wRVU
    —

How to choose

43870Gastrostomy closure
43870 addresses closure of a gastrostomy opening. billing code 43880 is for a fistula connecting the stomach and colon.
43810Gastroduodenostomy
43810 describes a gastroduodenal anastomosis, connecting the stomach and duodenum; it is not closure of a gastrocolic fistula.
43820Gastrojejunostomy
43820 describes a gastrojejunal anastomosis without vagotomy. Choose 43880 when the documented procedure closes a stomach-to-colon fistula.

Codes related to 43880

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

Codes related to 43880
CodeHow it relatesNational office range
Used instead
43870Gastrostomy closureFor surgical closure of a gastrostomy opening, rather than a stomach-to-colon fistula.No office rate

43880 billing questions

How is this different from surgical gastrostomy closure, 43870?

43880 closes a connection between the stomach and colon. Use 43870 for surgical closure of a gastrostomy opening.

What documentation supports 43880?

The operative report should identify the gastrocolic fistula and describe the surgical closure performed. Document other distinct procedures separately.

Is the day-before visit included in the global period?

Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How is 43880 paid when other 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.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

Should modifier 50 be appended?

No. The anatomy and service do not support bilateral reporting, so modifier 50 is inappropriate.

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 43880PPRRVU2026_Oct_nonQPP.csv, line 5,315 (RVU26D)

Open CMS sourceHow we calculate rates

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