No office rate
Use 43653 for laparoscopic creation of the gastrostomy; 43830 describes the open approach.
On this page
CMS RVU26D · Effective 2026-10-01
43653 Gastrostomy Medicare reimbursement rates in Arkansas
Report laparoscopic surgical gastrostomy when the surgeon establishes stomach-to-skin access, typically for enteral feeding, using a minimally invasive abdominal approach. Compare 43653 office and facility rates across CMS payment localities in Arkansas.
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.
What does Medicare pay for 43653 in Arkansas?
Arkansas has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$499.59
1 of 1 localities have a supported rate.
Payment area: Arkansas
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Gastrointestinal surgery
About 43653: Laparoscopic surgical gastrostomy
Report laparoscopic surgical gastrostomy when the surgeon establishes stomach-to-skin access, typically for enteral feeding, using a minimally invasive abdominal approach.
The surgeon uses laparoscopic access to bring the stomach to the abdominal wall and create a gastrostomy opening for a feeding tube, without forming a separate gastric tube or conduit. This approach may be selected when a patient needs long-term enteral access and the surgeon performs the placement in the operating room. General and other surgeons with appropriate training commonly perform the procedure in a hospital facility.
Report 43653 when the operative documentation supports laparoscopic creation of the gastrostomy; distinguish it from access placed endoscopically, radiologically, or through an open incision. Documentation should identify the approach, the stomach-to-abdominal-wall opening, and the tube or access established. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43653
- 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 RVU8.27 · 49%
- Practice expense (office) RVU6.49 · 38%
- Malpractice RVU2.16 · 13%
2.7K
Medicare services in 2024 · #2252 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.
43653 compared with similar codes
Office rates for Arkansas, from the same CMS release.
$690.21
Use 49440 for percutaneous gastrostomy placement under radiologic guidance, not a surgeon's laparoscopic procedure.
No office rate
Use 43246 when the gastrostomy tube is placed endoscopically; 43653 requires a laparoscopic surgical approach.
43659
No office rateUnlisted laps px stomach
43653 specifically describes laparoscopic gastrostomy. 43659 is for a laparoscopic stomach procedure without a more specific code.
Compare 43653 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arkansas →
Office / nonfacility
Unavailable
Facility
$499.59
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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 43653 in Arkansas.
PPRRVU2026_Oct_nonQPP.csv
5,281
- Code
- 43653
- Physician work
- 8.27
- Practice expense
- 6.49
- Malpractice
- 2.16
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.27 | × 1.000 | 8.2700 |
| Practice expense | 6.49 | × 0.859 | 5.5749 |
| Malpractice | 2.16 | × 0.515 | 1.1124 |
| Total RVUs | 14.9573 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$499.59
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.27 | 1 |
| Practice expense | 6.49 | 0.859 |
| Malpractice | 2.16 | 0.515 |
(8.27 × 1 + 6.49 × 0.859 + 2.16 × 0.515) × $33.4009 = $499.59
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.
43653 billing questions
How is 43653 different from an open gastrostomy?
43653 is for a laparoscopic approach. An open incision approach is reported with the applicable open gastrostomy code, such as 43830.
Can 43653 be reported for a radiologic or endoscopic tube placement?
No. Use 43653 when the surgeon creates the gastrostomy laparoscopically; radiologic and endoscopic approaches have distinct codes, including 49440 and 43246.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be paid for this procedure?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
Should modifier 50 be used for a gastrostomy?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
How does Medicare handle 43653 with another procedure in the same session?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple-procedure reduction.
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.
5,27843648,,Lap revise/remv eltrd antrum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27943651,,Laparoscopy vagus nerve,A,,9.88,6.47,NA,6.47,,2.63,18.98,18.98,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28043652,,Laparoscopy vagus nerve,A,,11.83,6.94,NA,6.94,,3.16,21.93,21.93,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28143653,,Laparoscopy gastrostomy,A,,8.27,6.49,NA,6.49,,2.16,16.92,16.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28243659,,Unlisted laps px stomach,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28343752,,Nasal/orogastric w/tube plmt,A,,0.79,0.15,NA,0.15,,0.09,1.03,1.03,0,000,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28443753,,Tx gastro intub w/asp,A,,0.44,0.09,NA,0.09,,0.08,0.61,0.61,0,000,0.00,0.00,0.00,0,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541