No office rate
Use 48146 when pancreaticojejunostomy is performed with the distal subtotal resection; 48145 describes the corresponding operation without it.
On this page
CMS RVU26D · Effective 2026-10-01
48146 Pancreatectomy Medicare reimbursement rates in Guam
Report this code for distal subtotal removal of the pancreas when the surgeon reconnects the remaining pancreatic tissue to the jejunum. Compare 48146 office and facility rates across CMS payment localities in Guam.
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 48146 in Guam?
Guam 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
$1724.84
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Pancreatic surgery
About 48146: Distal subtotal pancreatectomy with reconstruction
Report this code for distal subtotal removal of the pancreas when the surgeon reconnects the remaining pancreatic tissue to the jejunum.
The surgeon removes a substantial portion of the distal pancreas, generally the body and tail, and connects the remaining pancreatic tissue to the jejunum to drain pancreatic secretions. Splenectomy may be performed as part of the operation. This major abdominal procedure is typically performed by a surgeon in an operating room, often for pancreatic disease requiring more than a limited excision.
Select this code when the operative report supports a distal subtotal resection and pancreaticojejunostomy; the reconstruction is part of the coded service. Document the extent and location of the resection, the pancreatic remnant, and the anastomosis. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 48146
- 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 RVU29.84 · 56%
- Practice expense (office) RVU15.11 · 29%
- Malpractice RVU7.98 · 15%
75
Medicare services in 2024 · #5104 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.
48146 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
48140 describes a different distal partial pancreatectomy service. Use 48146 when the documented operation is distal subtotal resection with pancreaticojejunostomy.
No office rate
48150 is for a proximal subtotal pancreatic resection, while 48146 is for distal subtotal resection with pancreaticojejunostomy.
Compare 48146 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1724.84
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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 48146 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,739
- Code
- 48146
- Physician work
- 29.84
- Practice expense
- 15.11
- Malpractice
- 7.98
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 29.84 | × 1.000 | 29.8400 |
| Practice expense | 15.11 | × 1.137 | 17.1801 |
| Malpractice | 7.98 | × 0.579 | 4.6204 |
| Total RVUs | 51.6405 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1724.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 29.84 | 1 |
| Practice expense | 15.11 | 1.137 |
| Malpractice | 7.98 | 0.579 |
(29.84 × 1 + 15.11 × 1.137 + 7.98 × 0.579) × $33.4009 = $1724.84
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.
48146 billing questions
How does this differ from 48145?
Both describe distal subtotal pancreatectomy. Choose 48146 when the operation includes pancreaticojejunostomy; 48145 is the corresponding option without that reconstruction.
Is the pancreaticojejunostomy separately reported?
It is included in this service. The operative documentation should establish that the surgeon connected the pancreatic remnant to the jejunum.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this pancreatic operation.
What documentation supports this code?
The operative report should identify the distal subtotal extent of resection and describe the pancreaticojejunostomy. It should also clarify whether splenectomy was performed.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,73648120,,Removal of pancreas lesion,A,,17.95,8.60,NA,8.60,,4.80,31.35,31.35,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73748140,,Partial removal of pancreas,A,,25.66,11.51,NA,11.51,,6.44,43.61,43.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73848145,,Partial removal of pancreas,A,,26.71,11.75,NA,11.75,,7.14,45.60,45.60,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,73948146,,Pancreatectomy,A,,29.84,15.11,NA,15.11,,7.98,52.93,52.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74048148,,Removal of pancreatic duct,A,,19.88,10.09,NA,10.09,,5.30,35.27,35.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74148150,,Partial removal of pancreas,A,,51.52,21.52,NA,21.52,,12.92,85.96,85.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74248152,,Pancreatectomy,A,,47.43,19.90,NA,19.90,,12.70,80.03,80.03,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014