43800
No office ratePyloroplasty
Use for pyloric reconstruction or enlargement; 43520 is for incision of the pyloric muscle to relieve stenosis.
On this page
CMS RVU26D · Effective 2026-10-01
43520 in Beaumont
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$654.71
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Digestive surgery
About 43520: Pyloric muscle incision for stenosis
Reports surgical splitting of the pyloric muscle, typically to relieve gastric outlet obstruction from infantile hypertrophic pyloric stenosis.
This operation divides the thickened pyloric muscle to relieve narrowing at the stomach outlet while preserving the inner lining. It is most often performed by a pediatric surgeon for an infant with hypertrophic pyloric stenosis, in a hospital operating room. The code describes the pyloromyotomy service, not a gastric incision or a pyloric reconstruction.
Report it when the operative record supports incision of the pyloric muscle for the documented condition. The code has 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, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43520
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU11.01 · 54%
- Practice expense (office) RVU6.44 · 32%
- Malpractice RVU2.94 · 14%
93
Medicare services in 2024 · #4935 by national volume
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.
43520 compared with similar codes
Office rates for Beaumont, from the same CMS release.
43659
No office rateUnlisted laps px stomach
This is an unlisted laparoscopic stomach procedure code. It may be relevant when pyloromyotomy is performed laparoscopically rather than through an open approach.
No office rate
43500 describes a gastrotomy service involving an opening in the stomach; 43520 targets the pyloric muscle.
The same code, a different location
How does Beaumont compare?
43520 across payment areas
Same release and payment basis · bars start at $0
Beaumont · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 43520
Office
Unavailable
Facility
$660.55
No comparable office rate is available.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 43520
Office
Unavailable
Facility
$702.49
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 43520
Office
Unavailable
Facility
$750.29
No comparable office rate is available.
Miami
Florida · 43520
Office
Unavailable
Facility
$840.01
No comparable office rate is available.
Chicago
Illinois · 43520
Office
Unavailable
Facility
$811.86
No comparable office rate is available.
Manhattan
New York · 43520
Office
Unavailable
Facility
$796.97
No comparable office rate is available.
Alaska*
Alaska · 43520
Office
Unavailable
Facility
$834.81
No comparable office rate is available.
Alabama
Alabama · 43520
Office
Unavailable
Facility
$611.54
No comparable office rate is available.
Arkansas
Arkansas · 43520
Office
Unavailable
Facility
$603.09
No comparable office rate is available.
Arizona
Arizona · 43520
Office
Unavailable
Facility
$660.24
No comparable office rate is available.
Bakersfield
California · 43520
Office
Unavailable
Facility
$670.29
No comparable office rate is available.
Chico
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
El Centro
California · 43520
Office
Unavailable
Facility
$662.87
No comparable office rate is available.
Fresno
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Hanford-Corcoran
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Madera
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Merced
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Modesto
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Napa
California · 43520
Office
Unavailable
Facility
$724.30
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 43520
Office
Unavailable
Facility
$693.47
No comparable office rate is available.
Redding
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Rest Of California
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 43520
Office
Unavailable
Facility
$693.88
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 43520
Office
Unavailable
Facility
$683.78
No comparable office rate is available.
Salinas
California · 43520
Office
Unavailable
Facility
$681.08
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 43520
Office
Unavailable
Facility
$689.26
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 43520
Office
Unavailable
Facility
$751.05
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 43520
Office
Unavailable
Facility
$747.71
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 43520
Office
Unavailable
Facility
$771.01
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 43520
Office
Unavailable
Facility
$757.36
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 43520
Office
Unavailable
Facility
$671.63
No comparable office rate is available.
Santa Cruz-Watsonville
California · 43520
Office
Unavailable
Facility
$689.45
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 43520
Office
Unavailable
Facility
$681.48
No comparable office rate is available.
Santa Rosa-Petaluma
California · 43520
Office
Unavailable
Facility
$695.56
No comparable office rate is available.
Stockton
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Vallejo
California · 43520
Office
Unavailable
Facility
$719.49
No comparable office rate is available.
Visalia
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Yuba City
California · 43520
Office
Unavailable
Facility
$662.38
No comparable office rate is available.
Colorado
Colorado · 43520
Office
Unavailable
Facility
$677.72
No comparable office rate is available.
Connecticut
Connecticut · 43520
Office
Unavailable
Facility
$725.58
No comparable office rate is available.
Delaware
Delaware · 43520
Office
Unavailable
Facility
$670.38
No comparable office rate is available.
Fort Lauderdale
Florida · 43520
Office
Unavailable
Facility
$763.19
No comparable office rate is available.
Rest Of Florida
Florida · 43520
Office
Unavailable
Facility
$720.97
No comparable office rate is available.
Atlanta
Georgia · 43520
Office
Unavailable
Facility
$705.33
No comparable office rate is available.
Rest Of Georgia
Georgia · 43520
Office
Unavailable
Facility
$676.67
No comparable office rate is available.
Hawaii, Guam
Hawaii · 43520
Office
Unavailable
Facility
$669.17
No comparable office rate is available.
Iowa
Iowa · 43520
Office
Unavailable
Facility
$603.55
No comparable office rate is available.
Idaho
Idaho · 43520
Office
Unavailable
Facility
$612.09
No comparable office rate is available.
East St. Louis
Illinois · 43520
Office
Unavailable
Facility
$763.41
No comparable office rate is available.
Rest Of Illinois
Illinois · 43520
Office
Unavailable
Facility
$717.62
No comparable office rate is available.
Suburban Chicago
Illinois · 43520
Office
Unavailable
Facility
$765.24
No comparable office rate is available.
Indiana
Indiana · 43520
Office
Unavailable
Facility
$614.87
No comparable office rate is available.
Kansas
Kansas · 43520
Office
Unavailable
Facility
$611.69
No comparable office rate is available.
Kentucky
Kentucky · 43520
Office
Unavailable
Facility
$648.82
No comparable office rate is available.
New Orleans
Louisiana · 43520
Office
Unavailable
Facility
$681.71
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 43520
Office
Unavailable
Facility
$652.18
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 43520
Office
Unavailable
Facility
$727.05
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 43520
Office
Unavailable
Facility
$678.39
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 43520
Office
Unavailable
Facility
$725.90
No comparable office rate is available.
Rest Of Maryland
Maryland · 43520
Office
Unavailable
Facility
$679.25
No comparable office rate is available.
Rest Of Maine
Maine · 43520
Office
Unavailable
Facility
$626.72
No comparable office rate is available.
Southern Maine
Maine · 43520
Office
Unavailable
Facility
$642.87
No comparable office rate is available.
Detroit
Michigan · 43520
Office
Unavailable
Facility
$740.88
No comparable office rate is available.
Rest Of Michigan
Michigan · 43520
Office
Unavailable
Facility
$675.00
No comparable office rate is available.
Minnesota
Minnesota · 43520
Office
Unavailable
Facility
$618.15
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 43520
Office
Unavailable
Facility
$665.66
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 43520
Office
Unavailable
Facility
$670.92
No comparable office rate is available.
Rest Of Missouri
Missouri · 43520
Office
Unavailable
Facility
$648.81
No comparable office rate is available.
Mississippi
Mississippi · 43520
Office
Unavailable
Facility
$625.52
No comparable office rate is available.
Montana**
Montana · 43520
Office
Unavailable
Facility
$680.85
No comparable office rate is available.
North Carolina
North Carolina · 43520
Office
Unavailable
Facility
$631.18
No comparable office rate is available.
North Dakota**
North Dakota · 43520
Office
Unavailable
Facility
$622.71
No comparable office rate is available.
Nebraska
Nebraska · 43520
Office
Unavailable
Facility
$603.40
No comparable office rate is available.
New Hampshire
New Hampshire · 43520
Office
Unavailable
Facility
$677.59
No comparable office rate is available.
Northern Nj
New Jersey · 43520
Office
Unavailable
Facility
$745.31
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 43520
Office
Unavailable
Facility
$725.07
No comparable office rate is available.
New Mexico
New Mexico · 43520
Office
Unavailable
Facility
$682.93
No comparable office rate is available.
Nevada**
Nevada · 43520
Office
Unavailable
Facility
$664.86
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 43520
Office
Unavailable
Facility
$829.39
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 43520
Office
Unavailable
Facility
$738.65
No comparable office rate is available.
Queens
New York · 43520
Office
Unavailable
Facility
$787.13
No comparable office rate is available.
Rest Of New York
New York · 43520
Office
Unavailable
Facility
$641.12
No comparable office rate is available.
Ohio
Ohio · 43520
Office
Unavailable
Facility
$663.12
No comparable office rate is available.
Oklahoma
Oklahoma · 43520
Office
Unavailable
Facility
$636.13
No comparable office rate is available.
Portland
Oregon · 43520
Office
Unavailable
Facility
$685.67
No comparable office rate is available.
Rest Of Oregon
Oregon · 43520
Office
Unavailable
Facility
$651.02
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 43520
Office
Unavailable
Facility
$715.44
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 43520
Office
Unavailable
Facility
$658.01
No comparable office rate is available.
Puerto Rico
Puerto Rico · 43520
Office
Unavailable
Facility
$681.94
No comparable office rate is available.
Rhode Island
Rhode Island · 43520
Office
Unavailable
Facility
$684.52
No comparable office rate is available.
South Carolina
South Carolina · 43520
Office
Unavailable
Facility
$649.97
No comparable office rate is available.
South Dakota**
South Dakota · 43520
Office
Unavailable
Facility
$615.84
No comparable office rate is available.
Tennessee
Tennessee · 43520
Office
Unavailable
Facility
$616.00
No comparable office rate is available.
Utah
Utah · 43520
Office
Unavailable
Facility
$658.12
No comparable office rate is available.
Virginia
Virginia · 43520
Office
Unavailable
Facility
$648.52
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 43520
Office
Unavailable
Facility
$681.94
No comparable office rate is available.
Vermont
Vermont · 43520
Office
Unavailable
Facility
$630.38
No comparable office rate is available.
Rest Of Washington
Washington · 43520
Office
Unavailable
Facility
$673.76
No comparable office rate is available.
Seattle (King Cnty)
Washington · 43520
Office
Unavailable
Facility
$730.29
No comparable office rate is available.
Wisconsin
Wisconsin · 43520
Office
Unavailable
Facility
$604.06
No comparable office rate is available.
West Virginia
West Virginia · 43520
Office
Unavailable
Facility
$695.19
No comparable office rate is available.
Wyoming**
Wyoming · 43520
Office
Unavailable
Facility
$655.51
No comparable office rate is available.
See how rates vary across the country
43520 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Beaumont is a Medicare payment area. Our Census mapping connects it to 13 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 43520 in Beaumont. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$720.18
$654.71 × 110% = $720.18
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43520 in Beaumont.
PPRRVU2026_Oct_nonQPP.csv
5,261
- Code
- 43520
- Physician work
- 11.01
- Practice expense
- 6.44
- Malpractice
- 2.94
GPCI2026.csv
97
- Locality
- Beaumont
- Physician work
- 1.000
- Practice expense
- 0.910
- Malpractice
- 0.929
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.01 | × 1.000 | 11.0100 |
| Practice expense | 6.44 | × 0.910 | 5.8604 |
| Malpractice | 2.94 | × 0.929 | 2.7313 |
| Total RVUs | 19.6017 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Beaumont$654.71
Open 43520 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.01 | 1 |
| Practice expense | 6.44 | 0.91 |
| Malpractice | 2.94 | 0.929 |
(11.01 × 1 + 6.44 × 0.91 + 2.94 × 0.929) × $33.4009 = $654.71
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
43520 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $654.71 | RVU26D |
| 2026-07-01 | Not available in this setting | $654.71 | RVU26C |
| 2026-04-01 | Not available in this setting | $654.71 | RVU26B |
| 2026-01-01 | Not available in this setting | $654.71 | RVU26A |
| 2025-10-01 | Not available in this setting | $671.33 | RVU25D |
| 2025-07-01 | Not available in this setting | $671.33 | RVU25C |
| 2025-04-01 | Not available in this setting | $671.33 | RVU25B |
| 2025-01-01 | Not available in this setting | $671.33 | RVU25A |
43520 billing questions
How is this different from pyloroplasty?
Pyloromyotomy splits the pyloric muscle to relieve stenosis; pyloroplasty surgically enlarges or reconstructs the pylorus. Choose based on the operation documented, not simply the presence of gastric outlet narrowing.
Can this code be used for a laparoscopic pyloromyotomy?
The code describes pyloric muscle incision. For a laparoscopic approach, check the applicable coding guidance for reporting the service, which may involve an unlisted laparoscopic code.
Are routine postoperative visits separately reported?
Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.
Should modifier 50 be appended for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting this service?
The operative report should identify the pyloric muscle incision and the clinical indication, such as hypertrophic pyloric stenosis. It should distinguish the procedure from a pyloroplasty or an incision of the stomach.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,25843502,,Surgical repair of stomach,A,,25.05,10.87,NA,10.87,,6.69,42.61,42.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2594350F,,Cnslng provided symp mngmnt,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26043510,,Surgical opening of stomach,A,,14.76,8.37,NA,8.37,,3.93,27.06,27.06,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26143520,,Incision of pyloric muscle,A,,11.01,6.44,NA,6.44,,2.94,20.39,20.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26243605,,Biopsy of stomach,A,,13.38,7.01,NA,7.01,,3.58,23.97,23.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26343610,,Excision of stomach lesion,A,,15.93,7.54,NA,7.54,,4.07,27.54,27.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26443611,,Excision of stomach lesion,A,,19.87,9.57,NA,9.57,,4.96,34.40,34.40,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780
9904412,TX,11,DALLAS,1.009,0.996,0.858
10004412,TX,28,FORT WORTH,1.009,0.986,0.871