Billing code 48547: Duodenal exclusionMedicare rate & RVUs in Guam
Reports an operation that diverts gastric contents away from the duodenum, commonly to protect a repair during treatment of complex duodenal injury.
CMS doesn’t publish an office rate for 48547 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 48547 covers
The surgeon diverts gastric flow away from the duodenum, typically by closing the pyloric outlet and creating a route from the stomach to the small bowel. The operation is used in selected cases of severe duodenal injury, including trauma in which a duodenal repair needs protection; pancreatic injury may also be present. It is performed in the operating room by a surgeon, generally as part of major abdominal surgery.
Report this code when the operative note documents the duodenal-exclusion procedure, not merely a bypass or repair of another organ. The diagnosis alone does not establish that exclusion was performed; documentation should identify the diversion and the operative work. 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 other procedures are subject to the standard multiple procedure reduction. An assistant at surgery may be paid; co-surgeons require 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.
48547 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,609.81 |
How the 48547 rate is calculated
Each of 48547’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 · 48547
RVUs × geographic indexes × conversion factor
Work29.62
29.62 RVUs× 1.000 GPCI
Practice expense12.30
12.30 RVUs× 1.000 GPCI
Malpractice7.93
7.93 RVUs× 1.000 GPCI
Adjusted RVUs
49.8500
Conversion factor
$33.4009
Medicare rate
$1,665.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 48547
48547 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 48547
Duodenal exclusion
| 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 · 48547
Duodenal exclusion
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
48547 without 51 · national facility
$1,665.03
Duodenal exclusion
48547-51 · Second procedure: 50%
$832.52
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%).
48547 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43820Gastrojejunostomy
- A gastrojejunostomy creates a stomach-to-small-bowel connection. Report duodenal exclusion only when the operation also diverts flow away from the duodenum.
- 48545Pancreas repair
- Pancreatorrhaphy describes repair of the pancreas. Duodenal exclusion describes diversion of gastric flow; both may be performed when injuries involve both structures.
- 48150Whipple procedure
- This code describes pancreaticoduodenectomy, a resection operation involving the pancreatic head and duodenum. Duodenal exclusion is a diversion procedure rather than that resection.
48547 billing questions
How is duodenal exclusion different from a gastrojejunostomy alone?
Duodenal exclusion diverts flow away from the duodenum as an operative strategy; a gastrojejunostomy alone describes a connection between the stomach and small bowel. Use this code only when the documented operation includes exclusion.
Can a pancreatic repair be reported during the same operation?
A separately performed pancreatic repair may be reported when the operative record supports that distinct work. The duodenal-exclusion code does not, by itself, describe pancreatic repair.
What documentation supports reporting this code?
The operative report should identify the duodenal diversion and the steps performed, rather than relying only on a diagnosis of duodenal trauma or injury.
Does the code have a postoperative global period?
Yes. CMS assigns a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
How does the multiple procedure rule affect payment?
When this operation and other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures 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 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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