No office rate
Choose 43501 for suture repair of a bleeding gastric ulcer. Choose 43502 for a perforated gastric ulcer.
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CMS RVU26D · Effective 2026-10-01
43502 Gastric repair Medicare reimbursement rates in Illinois
Reports gastrotomy with suture repair of a perforated gastric ulcer, typically during operative treatment of an acute stomach perforation. Compare 43502 office and facility rates across CMS payment localities in Illinois.
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 43502 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1517.43–$1720.25
4 of 4 localities have a supported rate.
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.
Where 43502 pays more and less in Illinois
Digestive surgery
About 43502: Gastrotomy with perforated ulcer repair
Reports gastrotomy with suture repair of a perforated gastric ulcer, typically during operative treatment of an acute stomach perforation.
This operation opens the stomach to reach and suture a perforated gastric ulcer. A surgeon typically performs it in a hospital operating room when operative management is needed for a gastric ulcer perforation. The operative report should identify the perforation and describe the gastrotomy and repair, distinguishing this service from repair of a bleeding ulcer or a gastrotomy performed for another purpose.
Report the code for the perforated-ulcer repair, not simply for opening or exploring the stomach. The gastrotomy used to access and repair the ulcer is part of the service. 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. Do not append modifier 50; the stomach is not a bilateral site. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 43502
- 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 RVU25.05 · 59%
- Practice expense (office) RVU10.87 · 26%
- Malpractice RVU6.69 · 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.
43502 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
43500 describes gastrotomy for exploration or drainage; 43502 includes suture repair of a perforated gastric ulcer.
No office rate
43510 is a gastrotomy for insertion of a tube, such as a feeding tube, rather than repair of a perforated ulcer.
No office rate
43840 describes gastrorrhaphy for a perforated gastric ulcer, wound, or injury. Distinguish it from 43502 by the documented procedure and whether gastrotomy is performed.
Compare 43502 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$1720.25
East St. Louis →
Office / nonfacility
Unavailable
Facility
$1620.75
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$1517.43
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$1611.38
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43502 billing questions
How does this differ from 43501?
43502 is for gastrotomy with suture repair of a perforated gastric ulcer. 43501 is for suture repair of a bleeding gastric ulcer.
Can 43500 be reported separately for the gastrotomy?
The gastrotomy is the access used for the repair described by 43502. Do not separately report 43500 for that same opening.
What documentation supports 43502?
The operative report should identify a perforated gastric ulcer and describe the gastrotomy and suture repair. Documentation should distinguish the case from repair of a bleeding ulcer.
Can modifier 50 be used?
No. Modifier 50 is inappropriate for this stomach procedure.
How does the global period affect postoperative care?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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.
5,25543499,,Unlisted procedure esophagus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25643500,,Surgical opening of stomach,A,,12.47,6.79,NA,6.79,,3.25,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25743501,,Surgical repair of stomach,A,,22.04,10.11,NA,10.11,,5.83,37.98,37.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25843502,,Surgical repair of stomach,A,,25.05,10.87,NA,10.87,,6.69,42.61,42.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2594350F,,Cnslng provided symp mngmnt,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26043510,,Surgical opening of stomach,A,,14.76,8.37,NA,8.37,,3.93,27.06,27.06,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26143520,,Incision of pyloric muscle,A,,11.01,6.44,NA,6.44,,2.94,20.39,20.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00