Billing code 43520: PyloromyotomyMedicare rate & RVUs in Alaska
Reports surgical splitting of the pyloric muscle, typically to relieve gastric outlet obstruction from infantile hypertrophic pyloric stenosis.
CMS doesn’t publish an office rate for 43520 in Alaska.
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 9 sections
What 43520 covers
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.
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 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $834.81 |
How the 43520 rate is calculated
Each of 43520’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 · 43520
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 11.01Practice expense 6.44Malpractice 2.94
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43520
43520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43520
Pyloromyotomy
| 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 · 43520
Pyloromyotomy
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
43520 without 51 · national facility
$681.04
Pyloromyotomy
43520-51 · Second procedure: 50%
$340.52
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%).
43520 compared with similar codes
Compare codes
43520 vs 43800 vs 43659 vs 43500: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43800Pyloroplasty
- Use for pyloric reconstruction or enlargement; 43520 is for incision of the pyloric muscle to relieve stenosis.
- 43659Unlisted 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.
- 43500Gastrotomy
- 43500 describes a gastrotomy service involving an opening in the stomach; 43520 targets the pyloric muscle.
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 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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