No office rate
Choose 43860 when the surgeon revises the existing gastrojejunal anastomosis without performing vagotomy; 43865 includes both services.
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CMS RVU26D · Effective 2026-10-01
43865 Anastomosis revision Medicare reimbursement rates in Idaho
Revision of an existing gastrojejunal connection with vagotomy is reported when the surgeon revises the anastomosis and divides vagal nerves during the same operation. Compare 43865 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 43865 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
$1423.81
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 43865: Gastrojejunal anastomosis revision with vagotomy
Revision of an existing gastrojejunal connection with vagotomy is reported when the surgeon revises the anastomosis and divides vagal nerves during the same operation.
This code describes an operation on an existing connection between the stomach and jejunum, with vagotomy performed as part of the revision. Surgeons may revise the connection to address problems such as narrowing or recurrent ulceration; the vagotomy reduces vagal stimulation of acid secretion. The procedure is typically performed by a general or upper gastrointestinal surgeon in a hospital operating room, including in patients with prior gastric surgery.
Report the code when the operative record supports both revision of the existing gastrojejunal anastomosis and vagotomy. A revision without vagotomy is distinguished by 43860, while construction of a new gastrojejunostomy is a different service. The 90-day global period 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 the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43865
- 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 RVU28.32 · 60%
- Practice expense (office) RVU11.66 · 25%
- Malpractice RVU7.57 · 16%
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.
43865 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
43825 describes gastrojejunostomy with vagotomy, not revision of an existing gastrojejunal anastomosis.
No office rate
43820 describes gastrojejunostomy without vagotomy; 43865 is for revision of an existing connection with vagotomy.
No office rate
43848 is for revision of an open gastric restrictive procedure. Use 43865 when the operation revises the gastrojejunal anastomosis and includes vagotomy.
Compare 43865 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
$1423.81
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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 43865 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,313
- Code
- 43865
- Physician work
- 28.32
- Practice expense
- 11.66
- Malpractice
- 7.57
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 28.32 | × 1.000 | 28.3200 |
| Practice expense | 11.66 | × 0.920 | 10.7272 |
| Malpractice | 7.57 | × 0.473 | 3.5806 |
| Total RVUs | 42.6278 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$1423.81
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 28.32 | 1 |
| Practice expense | 11.66 | 0.92 |
| Malpractice | 7.57 | 0.473 |
(28.32 × 1 + 11.66 × 0.92 + 7.57 × 0.473) × $33.4009 = $1423.81
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.
43865 billing questions
How does 43865 differ from 43860?
43865 includes vagotomy along with revision of the existing gastrojejunal anastomosis. Use 43860 for the corresponding revision without vagotomy.
Does this code describe creation of a new gastrojejunostomy?
No. It describes revision of an existing gastrojejunal connection. Codes 43820 and 43825 describe gastrojejunostomy procedures rather than this revision service.
What documentation supports reporting 43865?
The operative report should identify the prior gastrojejunal anastomosis, the revision performed, and the vagotomy. Documentation of vagotomy alone does not support this code.
Can modifier 50 be used?
No. Bilateral adjustment does not apply to this procedure, and modifier 50 is inappropriate.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid. 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.
5,31043847,,Gstr rstcv px sm int rcnstj,A,,29.52,13.12,NA,13.12,,7.90,50.54,50.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31143848,,Revj open gstr rstcv px,A,,31.93,13.40,NA,13.40,,8.32,53.65,53.65,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31243860,,Revj gstr/jj anast w/o vgtmy,A,,27.19,11.29,NA,11.29,,6.91,45.39,45.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31343865,,Revj gstr/jj anast w/vgtmy,A,,28.32,11.66,NA,11.66,,7.57,47.55,47.55,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31443870,,Closure gastrostomy surgical,A,,11.15,6.30,NA,6.30,,2.72,20.17,20.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31543880,,Closure gastrocolic fistula,A,,26.50,11.22,NA,11.22,,7.09,44.81,44.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31643881,,Impl/rplcmt gstr nstim eltrd,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,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