No office rate
Both include distal partial gastrectomy and Roux-en-Y reconstruction. Choose 43634 when the documented procedure also includes vagotomy; choose 43633 without it.
On this page
CMS RVU26D · Effective 2026-10-01
43634 Partial gastrectomy Medicare reimbursement rates in Idaho
Reports open removal of the distal stomach with Roux-en-Y reconstruction and vagotomy, when the operative plan includes this combined procedure. Compare 43634 office and facility rates across CMS payment localities in Idaho.
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 43634 in Idaho?
Idaho 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
$1757.58
1 of 1 localities have a supported rate.
Payment area: Idaho
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 43634: Distal partial gastrectomy with Roux-en-Y and vagotomy
Reports open removal of the distal stomach with Roux-en-Y reconstruction and vagotomy, when the operative plan includes this combined procedure.
Code 43634 represents an open distal partial gastrectomy with Roux-en-Y reconstruction and vagotomy. A general surgeon performs the operation in an operating room, removing part of the stomach and connecting the remaining stomach to the jejunum through a Roux limb. The combined approach has been used for complicated or refractory peptic ulcer disease when resection and vagotomy are selected.
The operative report should support the extent of stomach removed, the Roux-en-Y reconstruction, and the vagotomy; a partial gastrectomy with a different reconstruction or without vagotomy belongs to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this stomach procedure. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43634
- 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 RVU35.72 · 61%
- Practice expense (office) RVU13.45 · 23%
- Malpractice RVU9.57 · 16%
26
Medicare services in 2024 · #5758 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.
43634 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
43631 uses gastroduodenostomy reconstruction. 43634 uses Roux-en-Y reconstruction and includes vagotomy.
No office rate
43632 uses gastrojejunostomy reconstruction. 43634 identifies the Roux-en-Y reconstruction with vagotomy.
No office rate
43620 represents total stomach removal, while 43634 is a distal partial resection with Roux-en-Y reconstruction and vagotomy.
Compare 43634 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
Idaho →
Office / nonfacility
Unavailable
Facility
$1757.58
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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 43634 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,271
- Code
- 43634
- Physician work
- 35.72
- Practice expense
- 13.45
- Malpractice
- 9.57
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 35.72 | × 1.000 | 35.7200 |
| Practice expense | 13.45 | × 0.920 | 12.3740 |
| Malpractice | 9.57 | × 0.473 | 4.5266 |
| Total RVUs | 52.6206 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1757.58
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 35.72 | 1 |
| Practice expense | 13.45 | 0.92 |
| Malpractice | 9.57 | 0.473 |
(35.72 × 1 + 13.45 × 0.92 + 9.57 × 0.473) × $33.4009 = $1757.58
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.
43634 billing questions
How is 43634 distinguished from 43633?
Both describe distal partial gastrectomy with Roux-en-Y reconstruction. Code 43634 includes vagotomy; 43633 is used when the documented procedure does not include vagotomy.
Can the vagotomy be reported separately?
Vagotomy is included in the procedure represented by 43634. Do not separately report another vagotomy code for that same operative work.
What operative details support 43634?
The operative report should document distal stomach resection, Roux-en-Y reconstruction, and vagotomy. A different reconstruction or a procedure without vagotomy points to a different code.
Does the 90-day global period include postoperative visits?
Yes. The global period 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-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction 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 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.
5,26843631,,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
5,27243635,,Removal of stomach partial,A,,2.01,0.48,NA,0.48,,0.53,3.02,3.02,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27343640,,Vagotomy & pylorus repair,A,,19.07,9.42,NA,9.42,,5.09,33.58,33.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27443641,,Vagotomy & pylorus repair,A,,19.31,9.48,NA,9.48,,5.15,33.94,33.94,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772