43831 Gastrostomy Medicare reimbursement rates in Illinois

A surgeon creates gastric access through an open abdominal operation in a neonate. The procedure may be chosen when an infant cannot take adequate nutrition by mouth and needs enteral access. Pediatric or general surgeons typically perform it in an operating room, often in an inpatient setting. The operative report should support the neonatal patient population, open approach, and creation of the gastrostomy.

Select this code for the neonatal open procedure rather than an endoscopic or image-guided placement. Document the operative method and any details that distinguish it from other open gastrostomy services. The code has 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate.