Billing code 43510: GastrotomyMedicare rate & RVUs in Guam
Open gastric access with repair of a perforated ulcer is reported when the surgeon enters the stomach to perform the ulcer repair.
CMS doesn’t publish an office rate for 43510 in Guam.
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 43510 covers
This code describes an open operation in which the surgeon makes an incision into the stomach to access and repair a perforated ulcer. It is a major abdominal procedure typically performed by a general or gastrointestinal surgeon in a hospital operating room. The operative report should identify the perforation, the gastric access and repair performed, and any associated procedures.
Report the code for the gastrotomy-based repair, rather than for exploration, biopsy, or repair of a bleeding ulcer alone. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Modifier 50 is inappropriate for this single-organ procedure. Assistant-at-surgery payment may be available; 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.
43510 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $886.87 |
How the 43510 rate is calculated
Each of 43510’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 · 43510
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 14.76Practice expense 8.37Malpractice 3.93
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43510
43510 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43510
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 · 43510
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
43510 without 51 · national facility
$903.83
Gastrotomy
43510-51 · Second procedure: 50%
$451.92
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%).
43510 compared with similar codes
Compare codes
43510 vs 43500 vs 43501 vs 43502 vs 43840: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43500Gastrotomy
- 43500 describes gastrotomy for exploration or foreign body removal. Choose 43510 when the gastrotomy is used for perforated ulcer repair.
- 43501Gastric repair
- 43501 is for gastric biopsy through a gastrotomy. It does not describe repair of a perforated ulcer.
- 43502Gastric repair
- 43502 addresses suture repair of a bleeding ulcer; 43510 is associated with perforation.
- 43840Ulcer repair
- 43840 describes direct suture repair of a perforated gastric or duodenal ulcer, wound, or injury. Distinguish it by the operation documented and whether the gastrotomy-based service represented by 43510 was performed.
43510 billing questions
How is this code different from 43500?
Use 43510 for gastrotomy-based repair of a perforated ulcer. Code 43500 describes gastrotomy for exploration or foreign body removal.
Is this the code for repairing a bleeding ulcer?
No. Code 43502 is the related gastrotomy code for suture repair of a bleeding ulcer; 43510 is for a perforated ulcer.
What documentation supports reporting 43510?
The operative report should establish the perforated ulcer and describe the gastric incision and repair performed. Include any separately performed procedures in the operative documentation.
Can an assistant surgeon be reported?
CMS indicates that assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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 paid at 50% when performed in the same session.
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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