Billing code 48154: PancreaticoduodenectomyMedicare rate & RVUs in Illinois
Reports a pylorus-preserving Whipple-type operation that removes the pancreatic head and duodenum while reconnecting the remaining pancreas to the intestine.
CMS doesn’t publish an office rate for 48154 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 48154 covers
This operation removes the proximal portion of the pancreas and the duodenum while preserving the pylorus, the stomach’s outlet. The surgeon reconnects the remaining pancreas to the intestine and restores the digestive tract after resection. A pancreatic surgeon typically performs it in a hospital for selected tumors of the pancreatic head or periampullary region. Unlike a conventional Whipple operation that removes part of the stomach, the pylorus-preserving approach retains the gastric outlet.
Report 48154 when the operative note supports the pylorus-preserving resection and pancreatic-to-intestinal reconstruction. The note should identify the structures removed, preservation of the pylorus, and the connections created. Medicare treats it as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50% under the standard multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation. Team surgery is 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 48154 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 | $3,250.83 |
| East St. Louis | Unavailable | $3,063.28 |
| Rest Of Illinois | Unavailable | $2,866.41 |
| Suburban Chicago | Unavailable | $3,042.59 |
How the 48154 rate is calculated
Each of 48154’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 · 48154
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 47.66Practice expense 19.95Malpractice 12.76
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 48154
48154 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 48154
Pancreaticoduodenectomy
| 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 · 48154
Pancreaticoduodenectomy
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
48154 without 51 · national facility
$2,684.43
Pancreaticoduodenectomy
48154-51 · Second procedure: 50%
$1,342.22
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%).
48154 compared with similar codes
Compare codes
48154 vs 48150 vs 48153 vs 48155: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 48150Whipple procedure
- 48150 represents a conventional Whipple-type resection that includes partial removal of the stomach. Choose 48154 when the operative note documents a pylorus-preserving pancreaticoduodenectomy with pancreatic reconstruction.
- 48153Pancreaticoduodenectomy
- Both are proximal pancreatic resection variants. Use the operative report’s account of stomach removal or pylorus preservation and the reconstruction performed to distinguish them.
- 48155Pancreatectomy
- 48155 involves removal of the entire pancreas. Code 48154 describes a proximal subtotal resection that leaves pancreatic tissue for reconstruction.
48154 billing questions
How is 48154 distinguished from a conventional Whipple procedure?
Look for preservation of the pylorus and no partial gastrectomy. The operative report should also document the pancreatic-to-intestinal connection.
Can the pancreatic reconstruction be billed separately?
The pancreatic-to-intestinal reconstruction is part of the operation represented by 48154; do not separately report that connection as another pancreaticoduodenectomy.
Is modifier 50 appropriate for this operation?
No. The pancreas is not treated as a paired organ for a bilateral adjustment under this code.
How are other procedures in the same operative session paid?
The standard multiple-procedure reduction pays the highest-valued procedure in full and other procedures at 50%.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons require documentation supporting their distinct roles; 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 48154 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 →