No office rate
Choose 48520 when the cyst is joined to the stomach. Choose 48540 when the documented anastomosis is to intestine.
On this page
CMS RVU26D · Effective 2026-10-01
48520 Cystogastrostomy Medicare reimbursement rates in Idaho
Reports operative internal drainage of a pancreatic cyst into the stomach by creating a direct communication between the cyst cavity and gastric lumen. Compare 48520 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 48520 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
$928.20
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.
Pancreatic surgery
About 48520: Pancreatic cyst-to-stomach anastomosis
Reports operative internal drainage of a pancreatic cyst into the stomach by creating a direct communication between the cyst cavity and gastric lumen.
This service creates a drainage pathway from a pancreatic cyst or pseudocyst into the stomach. The surgeon opens the cyst cavity and stomach and joins them so the collection can drain internally. It is typically performed by a general or pancreatic surgeon in an operative setting for a collection suitable for drainage into the stomach; the key distinction is the stomach as the drainage destination.
Report 48520 when the operative work creates this cyst-to-stomach connection, rather than simply draining the collection or connecting it to another part of the bowel. The operative report should identify the pancreatic cyst or pseudocyst, the stomach, and the completed anastomosis. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
CMS billing rules for 48520
- 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 RVU17.70 · 57%
- Practice expense (office) RVU8.53 · 28%
- Malpractice RVU4.74 · 15%
38
Medicare services in 2024 · #5530 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.
48520 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
48510 represents pancreatic pseudocyst drainage. 48520 specifically represents internal drainage through an anastomosis to the stomach.
No office rate
48548 connects the pancreas to intestine; 48520 connects a cyst cavity to the stomach. The structure joined and destination differ.
Compare 48520 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
$928.20
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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 48520 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,750
- Code
- 48520
- Physician work
- 17.70
- Practice expense
- 8.53
- Malpractice
- 4.74
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.70 | × 1.000 | 17.7000 |
| Practice expense | 8.53 | × 0.920 | 7.8476 |
| Malpractice | 4.74 | × 0.473 | 2.2420 |
| Total RVUs | 27.7896 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$928.20
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.7 | 1 |
| Practice expense | 8.53 | 0.92 |
| Malpractice | 4.74 | 0.473 |
(17.7 × 1 + 8.53 × 0.92 + 4.74 × 0.473) × $33.4009 = $928.20
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.
48520 billing questions
How is 48520 different from 48540?
48520 connects the pancreatic cyst to the stomach. 48540 connects it to intestine, so the operative report's drainage destination determines the choice.
When would 48510 be considered instead?
48510 describes drainage of a pancreatic pseudocyst without the cyst-to-stomach anastomosis represented by 48520. Use the documented operative method to distinguish them.
What should the operative report document?
It should identify the pancreatic cyst or pseudocyst, the stomach as the destination, and creation of the communication between the two.
Does 48520 have a Medicare global period?
Yes. It has 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-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be used?
No. The bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
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.
5,74748400,,Injection intraop add-on,A,,1.90,0.46,NA,0.46,,0.49,2.85,2.85,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74848500,,Surgery of pancreatic cyst,A,,17.71,10.24,NA,10.24,,4.74,32.69,32.69,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74948510,,Drain pancreatic pseudocyst,A,,16.76,10.01,NA,10.01,,4.48,31.25,31.25,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,75048520,,Fuse pancreas cyst and bowel,A,,17.70,8.53,NA,8.53,,4.74,30.97,30.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,75148540,,Fuse pancreas cyst and bowel,A,,21.39,9.43,NA,9.43,,5.72,36.54,36.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,75248545,,Pancreatorrhaphy,A,,21.67,10.38,NA,10.38,,5.78,37.83,37.83,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,75348547,,Duodenal exclusion,A,,29.62,12.30,NA,12.30,,7.93,49.85,49.85,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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