CPT code 43641: Vagotomy2026 Medicare rate & RVUs in Illinois
Reports an open vagotomy combined with a pyloric drainage repair, typically performed to reduce acid secretion while facilitating passage of stomach contents.
CMS doesn’t publish an office rate for 43641 in Illinois.
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 43641 covers
This operation divides vagal nerve input to the stomach and includes a repair that widens or improves drainage through the pylorus. It is a nonlaparoscopic abdominal procedure performed by a surgeon, typically in a hospital operating room. A familiar clinical context is surgical treatment of peptic ulcer disease when acid-reducing surgery and improved gastric emptying are both part of the operative plan.
Select this code when the operative report supports both the vagotomy and the pyloric drainage procedure; a vagotomy without drainage is a different service. Documentation should identify the nerve procedure and describe the pyloric repair. The pyloric work is included in this combined service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
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.
Where 43641 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,362.48 |
| East St. Louis | Unavailable | $1,282.72 |
| Rest Of Illinois | Unavailable | $1,202.92 |
| Suburban Chicago | Unavailable | $1,279.49 |
How the 43641 rate is calculated
Each of 43641’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 · 43641
RVUs × geographic indexes × conversion factor
Work19.31
19.31 RVUs× 1.000 GPCI
Practice expense9.48
9.48 RVUs× 1.000 GPCI
Malpractice5.15
5.15 RVUs× 1.000 GPCI
Adjusted RVUs
33.9400
Conversion factor
$33.4009
Medicare rate
$1,133.63
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43641
43641 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43641
Vagotomy
| 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 · 43641
Vagotomy
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
43641 without 51 · national facility
$1,133.63
Vagotomy
43641-51 · Second procedure: 50%
$566.82
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%).
43641 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43640Vagotomy
- Choose 43641 when the vagotomy includes a pyloric drainage repair. Choose 43640 for a vagotomy without drainage.
- 43651Vagal electrode placement
- 43651 describes laparoscopic vagotomy without drainage. It differs from 43641 in both approach and the absence of a pyloric drainage procedure.
- 43652Vagotomy
- 43652 describes laparoscopic vagotomy with drainage. Use 43641 for the nonlaparoscopic operation with pyloric drainage.
43641 billing questions
How does this differ from 43640?
43641 includes a pyloric drainage repair with the vagotomy. Use 43640 when the documented vagotomy is performed without a drainage procedure.
Is the pyloric repair separately reported?
The pyloric drainage work is part of 43641. Do not report that same included work again as a separate service.
Should modifier 50 be appended?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this procedure.
What does the 90-day global period include?
It 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 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 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
Fee sheets
Put 43641 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →