No office rate
Choose 43632 when the gastric remnant is connected to the jejunum. This code describes direct reconnection to the duodenum.
On this page
CMS RVU26D · Effective 2026-10-01
43631 Partial gastrectomy Medicare reimbursement rates in Delaware
Open distal partial gastrectomy with reconnection of the remaining stomach to the duodenum, reported when resection and gastroduodenostomy are performed. Compare 43631 office and facility rates across CMS payment localities in Delaware.
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 43631 in Delaware?
Delaware 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
$1334.79
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Gastric surgery
About 43631: Distal partial gastrectomy with duodenal reconnection
Open distal partial gastrectomy with reconnection of the remaining stomach to the duodenum, reported when resection and gastroduodenostomy are performed.
This code describes an open operation removing the distal portion of the stomach and reconnecting the gastric remnant directly to the duodenum. General surgeons and surgical oncologists may perform it for a distal gastric tumor or other disease requiring removal of that portion of the stomach. The reconstruction is commonly called a Billroth I. It is distinct from a more limited excision of a stomach lesion and from removal of the entire stomach.
Report the code when the operative note supports distal partial resection and a gastroduodenostomy. Document the portion removed and the reconstruction performed; a different reconstruction may point to another partial-gastrectomy code. The 90-day global 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 a 50% 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 stomach operation.
CMS billing rules for 43631
- 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 RVU23.90 · 59%
- Practice expense (office) RVU10.55 · 26%
- Malpractice RVU6.14 · 15%
398
Medicare services in 2024 · #3741 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.
43631 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Choose 43633 for distal partial gastrectomy with Roux-en-Y reconstruction; this code is for gastroduodenostomy.
No office rate
43620 represents total gastrectomy. This code is for removing only the distal portion of the stomach and reconnecting the remnant to the duodenum.
Compare 43631 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
Delaware →
Office / nonfacility
Unavailable
Facility
$1334.79
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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 43631 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,268
- Code
- 43631
- Physician work
- 23.90
- Practice expense
- 10.55
- Malpractice
- 6.14
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.90 | × 1.005 | 24.0195 |
| Practice expense | 10.55 | × 0.988 | 10.4234 |
| Malpractice | 6.14 | × 0.899 | 5.5199 |
| Total RVUs | 39.9628 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1334.79
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.9 | 1.005 |
| Practice expense | 10.55 | 0.988 |
| Malpractice | 6.14 | 0.899 |
(23.9 × 1.005 + 10.55 × 0.988 + 6.14 × 0.899) × $33.4009 = $1334.79
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.
43631 billing questions
How is this code distinguished from 43632?
This code describes reconnection of the gastric remnant to the duodenum. Code 43632 is for a distal partial gastrectomy reconstructed to the jejunum.
When would 43633 be selected instead?
Use 43633 when the distal partial gastrectomy is reconstructed with a Roux-en-Y configuration rather than a direct connection to the duodenum.
Can a separate lesion excision be reported for the removed stomach?
The gastric resection is integral to this operation. Do not separately report a lesion excision for tissue removed as part of the gastrectomy.
What operative details support reporting this code?
The operative report should establish that the resection was partial and distal, and that the gastric remnant was connected to the duodenum.
How does the 90-day global affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgical payment.
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.
5,26543620,,Removal of stomach,A,,33.19,12.84,NA,12.84,,8.89,54.92,54.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26643621,,Removal of stomach,A,,38.54,14.30,NA,14.30,,9.78,62.62,62.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26743622,,Removal of stomach,A,,39.03,14.26,NA,14.26,,10.46,63.75,63.75,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26843631,,Removal of stomach partial,A,,23.90,10.55,NA,10.55,,6.14,40.59,40.59,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26943632,,Removal of stomach partial,A,,34.26,13.17,NA,13.17,,8.72,56.15,56.15,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27043633,,Removal of stomach partial,A,,32.31,12.65,NA,12.65,,8.21,53.17,53.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27143634,,Removal of stomach partial,A,,35.72,13.45,NA,13.45,,9.57,58.74,58.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503