Billing code 43500: GastrotomyMedicare rate & RVUs in Chico
Report this service when a surgeon opens the stomach during an operation to inspect it or obtain one or more gastric biopsies.
In Chico, Medicare pays $730.34 for 43500 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 43500 nationwide
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 11 sections
What 43500 covers
A surgeon makes an operative opening in the stomach to examine its interior or take biopsy tissue. General surgeons typically perform this procedure in a hospital operating room as part of abdominal surgery when direct access to the stomach is needed; it is not an endoscopic biopsy. The code covers exploration or one or more biopsies through the gastrotomy.
Choose the code when the operative record documents the gastric incision and its exploratory or biopsy purpose. The 90-day global period 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 the standard multiple-procedure 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 procedure.
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.
How Chico compares for 43500
Across 109 of 109 payment localities, the facility rate for 43500 runs from $666.87 in Nebraska to $927.13 in Miami. Chico pays $730.34. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Chico · this page$730.34
- Bakersfield · California$739.10+$8.76
- El Centro · California$730.88+$0.54
- Fresno · California$730.34
- Hanford-Corcoran · California$730.34
- Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$773.96+$43.62
- Madera · California$730.34
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| MercedCalifornia | — | $730.34 |
| ModestoCalifornia | — | $730.34 |
| NapaCalifornia | — | $796.81 |
| Oxnard-Thousand Oaks-VenturaCalifornia | — | $763.87 |
| ReddingCalifornia | — | $730.34 |
| Rest Of CaliforniaCalifornia | — | $730.34 |
| Riverside-San Bernardino-OntarioCalifornia | — | $765.17 |
| Sacramento-Roseville-FolsomCalifornia | — | $753.45 |
| SalinasCalifornia | — | $750.46 |
| San Diego-Chula Vista-CarlsbadCalifornia | — | $759.08 |
| San Francisco-Oakland-Berkeley (Marin Cnty)California | — | $825.68 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)California | — | $821.99 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty)California | — | $847.54 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)California | — | $832.45 |
| San Luis Obispo-Paso RoblesCalifornia | — | $740.09 |
| Santa Cruz-WatsonvilleCalifornia | — | $758.99 |
| Santa Maria-Santa BarbaraCalifornia | — | $750.80 |
| Santa Rosa-PetalumaCalifornia | — | $765.69 |
| StocktonCalifornia | — | $730.34 |
| VallejoCalifornia | — | $791.49 |
| VisaliaCalifornia | — | $730.34 |
| Yuba CityCalifornia | — | $730.34 |
| Dc + Md/Va SuburbsDistrict of Columbia | — | $826.98 |
| MiamiFlorida | — | $927.13 |
| ChicagoIllinois | — | $896.48 |
| ManhattanNew York | — | $878.86 |
| Alaska*Alaska | — | $926.11 |
| AlabamaAlabama | — | $676.39 |
| ArkansasArkansas | — | $667.23 |
| ArizonaArizona | — | $729.19 |
| ColoradoColorado | — | $747.59 |
| ConnecticutConnecticut | — | $800.44 |
| DelawareDelaware | — | $740.25 |
| Fort LauderdaleFlorida | — | $842.51 |
| Rest Of FloridaFlorida | — | $796.48 |
| AtlantaGeorgia | — | $778.55 |
| Rest Of GeorgiaGeorgia | — | $748.20 |
| Hawaii, GuamHawaii | — | $737.22 |
| IowaIowa | — | $667.12 |
| IdahoIdaho | — | $676.50 |
| East St. LouisIllinois | — | $843.78 |
| Rest Of IllinoisIllinois | — | $793.24 |
| Suburban ChicagoIllinois | — | $844.70 |
| IndianaIndiana | — | $679.50 |
| KansasKansas | — | $676.24 |
| KentuckyKentucky | — | $717.45 |
| New OrleansLouisiana | — | $753.24 |
| Rest Of LouisianaLouisiana | — | $721.21 |
| Metropolitan BostonMassachusetts | — | $800.99 |
| Rest Of MassachusettsMassachusetts | — | $748.50 |
| Baltimore/Surr. CntysMaryland | — | $800.80 |
| Rest Of MarylandMaryland | — | $749.84 |
| Rest Of MaineMaine | — | $692.68 |
| Southern MaineMaine | — | $709.76 |
| DetroitMichigan | — | $818.38 |
| Rest Of MichiganMichigan | — | $746.13 |
| MinnesotaMinnesota | — | $682.01 |
| Metropolitan Kansas CityMissouri | — | $735.52 |
| Metropolitan St. LouisMissouri | — | $741.19 |
| Rest Of MissouriMissouri | — | $717.73 |
| MississippiMississippi | — | $692.00 |
| Montana**Montana | — | $751.64 |
| North CarolinaNorth Carolina | — | $697.47 |
| North Dakota**North Dakota | — | $687.37 |
| NebraskaNebraska | — | $666.87 |
| New HampshireNew Hampshire | — | $747.58 |
| Northern NjNew Jersey | — | $821.76 |
| Rest Of New JerseyNew Jersey | — | $799.91 |
| New MexicoNew Mexico | — | $754.85 |
| Nevada**Nevada | — | $733.95 |
| Nyc Suburbs/Long IslandNew York | — | $914.40 |
| Poughkpsie/N Nyc SuburbsNew York | — | $814.94 |
| QueensNew York | — | $867.77 |
| Rest Of New YorkNew York | — | $708.27 |
| OhioOhio | — | $732.99 |
| OklahomaOklahoma | — | $703.38 |
| PortlandOregon | — | $755.90 |
| Rest Of OregonOregon | — | $718.71 |
| Metropolitan PhiladelphiaPennsylvania | — | $789.60 |
| Rest Of PennsylvaniaPennsylvania | — | $727.29 |
| Puerto RicoPuerto Rico | — | $752.72 |
| Rhode IslandRhode Island | — | $755.53 |
| South CarolinaSouth Carolina | — | $718.34 |
| South Dakota**South Dakota | — | $679.78 |
| TennesseeTennessee | — | $680.96 |
| AustinTexas | — | $753.47 |
| BeaumontTexas | — | $723.74 |
| BrazoriaTexas | — | $729.26 |
| DallasTexas | — | $739.28 |
| Fort WorthTexas | — | $738.42 |
| GalvestonTexas | — | $734.93 |
| HoustonTexas | — | $794.41 |
| Rest Of TexasTexas | — | $729.76 |
| UtahUtah | — | $727.17 |
| VirginiaVirginia | — | $716.08 |
| Virgin IslandsUnited States Virgin Islands | — | $752.72 |
| VermontVermont | — | $695.96 |
| Rest Of WashingtonWashington | — | $743.34 |
| Seattle (King Cnty)Washington | — | $804.30 |
| WisconsinWisconsin | — | $667.21 |
| West VirginiaWest Virginia | — | $768.93 |
| Wyoming**Wyoming | — | $723.63 |
43500 rates by state
Office rate range in each state. Select a state to see its payment localities.
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 every state and territory as a table
| State / territory | Office 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 |
How the 43500 rate is calculated
Each of 43500’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 · 43500
RVUs × geographic indexes × conversion factor
Work12.47
12.47 RVUs× 1.000 GPCI
Practice expense6.79
6.79 RVUs× 1.000 GPCI
Malpractice3.25
3.25 RVUs× 1.000 GPCI
Adjusted RVUs
22.5100
Conversion factor
$33.4009
Medicare rate
$751.85
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Chico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,256
- Code
- 43500
- Physician work
- 12.47
- Practice expense
- 6.79
- Malpractice
- 3.25
GPCI2026.csv
9
- Locality
- Chico
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.47 | × 1.017 | 12.6820 |
| Practice expense | 6.79 | × 1.096 | 7.4418 |
| Malpractice | 3.25 | × 0.536 | 1.7420 |
| Total RVUs | 21.8658 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Chico$730.34
Facility: (12.47 × 1.017 + 6.79 × 1.096 + 3.25 × 0.536) × $33.4009 = $730.34
Payment rules and modifiers for 43500
43500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43500
Gastrotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43500
Gastrotomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43500 without 51 · national facility
$751.85
Gastrotomy
43500-51 · Second procedure: 50%
$375.93
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%).
How 43500 has changed in Chico
43500 · 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
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $730.34 | RVU26D |
| 2026-07-01 | Not available in this setting | $730.34 | RVU26C |
| 2026-04-01 | Not available in this setting | $730.34 | RVU26B |
| 2026-01-01 | Not available in this setting | $730.34 | RVU26A |
| 2025-10-01 | Not available in this setting | $756.57 | RVU25D |
| 2025-07-01 | Not available in this setting | $756.57 | RVU25C |
| 2025-04-01 | Not available in this setting | $756.57 | RVU25B |
| 2025-01-01 | Not available in this setting | $756.57 | RVU25A |
| 2024-10-01 | Not available in this setting | $771.32 | RVU24D |
| 2022-07-01 | Not available in this setting | $798.23 | RVU22C |
| 2021-04-01 | Not available in this setting | $797.01 | RVU21B |
| 2021-01-01 | Not available in this setting | $797.01 | RVU21A |
| 2020-10-01 | Not available in this setting | $808.55 | RVU20D |
| 2020-07-01 | Not available in this setting | $808.55 | RVU20C |
| 2020-04-01 | Not available in this setting | $808.55 | RVU20B |
| 2020-01-01 | Not available in this setting | $808.55 | RVU20A |
| 2019-10-01 | Not available in this setting | $801.40 | RVU19D |
| 2019-07-01 | Not available in this setting | $801.40 | RVU19C |
| 2019-04-01 | Not available in this setting | $801.40 | RVU19B |
| 2019-01-01 | Not available in this setting | $801.40 | RVU19A |
| 2018-10-01 | Not available in this setting | $799.37 | RVU18D |
| 2018-07-01 | Not available in this setting | $799.37 | RVU18C |
| 2018-04-01 | Not available in this setting | $799.37 | RVU18B |
| 2018-01-01 | Not available in this setting | $799.37 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $807.63 | RVU17D |
| 2017-07-01 | Not available in this setting | $807.63 | RVU17C |
| 2017-04-01 | Not available in this setting | $807.63 | RVU17B |
| 2017-01-01 | Not available in this setting | $807.63 | RVU17A |
| 2016-10-01 | Not available in this setting | Rate data unavailable | RVU16D |
| 2016-07-01 | Not available in this setting | Rate data unavailable | RVU16C |
| 2016-04-01 | Not available in this setting | Rate data unavailable | RVU16B |
| 2016-01-01 | Not available in this setting | Rate data unavailable | RVU16A |
| 2015-10-01 | Not available in this setting | Rate data unavailable | RVU15D |
| 2015-07-01 | Not available in this setting | Rate data unavailable | RVU15C |
| 2015-04-01 | Not available in this setting | Rate data unavailable | RVU15B |
| 2015-01-01 | Not available in this setting | Rate data unavailable | RVU15A |
| 2014-10-01 | Not available in this setting | Rate data unavailable | RVU14D |
| 2014-07-01 | Not available in this setting | Rate data unavailable | RVU14C |
| 2014-04-01 | Not available in this setting | Rate data unavailable | RVU14B |
| 2014-01-01 | Not available in this setting | Rate data unavailable | RVU14A |
| 2013-10-01 | Not available in this setting | Rate data unavailable | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the Chico rate applies
Chico is a Medicare payment area, not a city. Our Census mapping connects it to 30 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
43500 billing questions
When should 43500 be reported instead of a gastric repair code?
Report 43500 when the stomach is opened for exploration or biopsy. A procedure whose purpose is to repair a gastric defect or lesion belongs to the applicable repair code instead.
Does 43500 cover multiple gastric biopsies?
Yes. The service includes one or more biopsies taken through the gastrotomy; do not report additional units of 43500 just for additional biopsy samples.
Can modifier 50 be used for a gastrotomy?
No. Modifier 50 is inappropriate for this procedure.
How does the 90-day global period affect billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session handled?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.
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
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