Billing code 43762: G-tube replacementMedicare rate & RVUs in Illinois
Reports percutaneous exchange of a gastrostomy tube through an established tract when the tract is not revised and imaging or endoscopic guidance is not used.
Medicare pays $253.91–$282.81 for 43762 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 43762 covers
This service covers replacing a gastrostomy tube through an established tract without revising that tract and without imaging or endoscopic guidance. It may be performed when a tube is damaged, clogged, or dislodged and needs exchange. Physicians and other qualified practitioners may perform the replacement in settings such as an office, hospital, or skilled nursing facility. Removal of the existing tube, when performed as part of the exchange, is included.
Report the code when documentation supports replacement through the existing tract and confirms that tract revision and imaging or endoscopic guidance were not required. A replacement requiring tract revision is distinguished from this service; fluoroscopic replacement is represented by a different code. The service has a 0-day global period, so same-day preoperative and postoperative care is included. 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. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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 43762 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.
4 payment localities
$253.91 to $282.81
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $280.09 | $41.09 |
| East St. Louis | $257.87 | $39.08 |
| Rest Of Illinois | $253.91 | $36.79 |
| Suburban Chicago | $282.81 | $38.58 |
How the 43762 rate is calculated
Each of 43762’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 · 43762
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense7.27
7.27 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
8.1500
Conversion factor
$33.4009
Medicare rate
$272.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43762
The CMS indicators that decide how 43762 is paid alongside other services.
CMS payment indicators · 43762
G-tube replacement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43762 without 51 · national office
$272.22
G-tube replacement
43762-51 · Second procedure: 50%
$136.11
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%).
43762 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43761G-tube repositioning
- 43761 is for repositioning the existing tube. Choose 43762 when the tube itself is exchanged through the established tract.
- 43763G-tube replacement
- Both codes report percutaneous tube replacement, but 43763 applies when the gastrostomy tract requires revision.
- 49450Feeding tube replacement
- Use 49450 for percutaneous gastrostomy tube replacement with imaging guidance; 43762 describes replacement without imaging or endoscopic guidance.
- 49440Gastrostomy placement
- 49440 reports placement of a gastrostomy tube. Code 43762 is for replacing a tube through an existing tract.
43762 billing questions
How does this differ from repositioning a gastrostomy tube?
Use 43762 when the tube is replaced through the established tract. Code 43761 describes repositioning the existing tube rather than exchanging it.
Is removal of the old tube separately reported?
No. Removal is included when performed as part of the replacement.
Can 43762 be used when the tract needs revision?
No. A replacement that requires revision of the gastrostomy tract is reported with 43763.
What if fluoroscopic guidance is used?
43762 describes replacement without imaging or endoscopic guidance. Fluoroscopic replacement is represented by 49450.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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
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