Billing code 43645: Gastric bypassMedicare rate & RVUs in Alaska
Reports laparoscopic gastric bypass with small-intestine reconstruction intended to limit absorption, rather than a standard Roux-en-Y bypass alone.
CMS doesn’t publish an office rate for 43645 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 43645 covers
A bariatric surgeon performs this laparoscopically to create a gastric bypass and reconstruct the small intestine in a way intended to limit nutrient absorption. It represents a more extensive intestinal reconstruction than a standard laparoscopic Roux-en-Y gastric bypass. The operation is typically performed in a hospital or other surgical facility for treatment of severe obesity; the operative report should identify the bypass and intestinal reconstruction performed.
Select this code when the documented laparoscopic operation includes both gastric bypass and the small-intestine reconstruction to limit absorption. A standard Roux-en-Y bypass without that reconstruction is reported with 43644. CMS assigns 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, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
43645 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $2,137.22 |
How the 43645 rate is calculated
Each of 43645’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 · 43645
RVUs × geographic indexes × conversion factor
Work30.74
30.74 RVUs× 1.000 GPCI
Practice expense12.59
12.59 RVUs× 1.000 GPCI
Malpractice8.11
8.11 RVUs× 1.000 GPCI
Adjusted RVUs
51.4400
Conversion factor
$33.4009
Medicare rate
$1,718.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43645
43645 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43645
Gastric bypass
| 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 · 43645
Gastric bypass
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
43645 without 51 · national facility
$1,718.14
Gastric bypass
43645-51 · Second procedure: 50%
$859.07
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%).
43645 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43644Gastric bypass
- 43644 describes laparoscopic Roux-en-Y gastric bypass. Choose 43645 when the operation also reconstructs the small intestine to limit absorption.
- 43847Bariatric surgery
- Both describe gastric bypass with intestinal reconstruction to limit absorption, but 43847 is the open approach; 43645 is laparoscopic.
- 43659Unlisted laps px stomach
- 43659 is an unlisted laparoscopic stomach procedure. Use 43645 when the documented bypass and intestinal reconstruction match its defined service.
43645 billing questions
How is 43645 distinguished from 43644?
Use 43645 when the laparoscopic gastric bypass includes small-intestine reconstruction intended to limit absorption. Code 43644 describes the laparoscopic Roux-en-Y bypass.
What operative documentation supports 43645?
The operative report should describe the laparoscopic approach, gastric bypass, and the small-intestine reconstruction that limits absorption. A statement that bariatric bypass was performed alone does not establish those details.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical global package.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team-surgery payment 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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