No office rate
Both codes describe gastrojejunostomy; choose 43825 when vagotomy is performed and 43820 when it is not.
On this page
CMS RVU26D · Effective 2026-10-01
43820 Gastrojejunostomy Medicare reimbursement rates in Indiana
Reports surgical creation of a stomach-to-jejunum connection without vagotomy, typically to bypass impaired gastric outflow or reconstruct gastrointestinal continuity. Compare 43820 office and facility rates across CMS payment localities in Indiana.
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 43820 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1136.78
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
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.
Gastrointestinal surgery
About 43820: Stomach-to-jejunum bypass without vagotomy
Reports surgical creation of a stomach-to-jejunum connection without vagotomy, typically to bypass impaired gastric outflow or reconstruct gastrointestinal continuity.
A surgeon creates an anastomosis between the stomach and jejunum, routing gastric contents past the usual outlet and intervening duodenum. General or gastrointestinal surgeons perform this operation in the operating room, commonly for gastric outlet obstruction or when reconstruction requires a stomach-to-small-bowel connection. The operative record should identify the anastomosis and whether vagotomy was performed; the presence of vagotomy distinguishes this service from its paired code.
Report 43820 for the gastrojejunostomy when no vagotomy is performed. Documentation should establish the surgical indication, the stomach-to-jejunum connection, and whether the procedure is an initial construction rather than revision of an existing anastomosis. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43820
- 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 RVU21.97 · 58%
- Practice expense (office) RVU10.11 · 27%
- Malpractice RVU5.54 · 15%
1.1K
Medicare services in 2024 · #2892 by national volume
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.
43820 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
The destination bowel segment differs: 43810 connects the stomach to the duodenum, while 43820 connects it to the jejunum.
No office rate
Code 43860 is for revision of an existing gastrojejunostomy without vagotomy, rather than creation of the connection.
43800
No office ratePyloroplasty
Code 43800 describes pyloroplasty, which treats the outlet by altering the pylorus; 43820 creates a stomach-to-jejunum bypass.
Compare 43820 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.
1 of 1 payment localities
Indiana →
Office / nonfacility
Unavailable
Facility
$1136.78
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43820 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,300
- Code
- 43820
- Physician work
- 21.97
- Practice expense
- 10.11
- Malpractice
- 5.54
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.97 | × 1.000 | 21.9700 |
| Practice expense | 10.11 | × 0.927 | 9.3720 |
| Malpractice | 5.54 | × 0.486 | 2.6924 |
| Total RVUs | 34.0344 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1136.78
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.97 | 1 |
| Practice expense | 10.11 | 0.927 |
| Malpractice | 5.54 | 0.486 |
(21.97 × 1 + 10.11 × 0.927 + 5.54 × 0.486) × $33.4009 = $1136.78
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
43820 billing questions
When should 43820 be selected instead of 43825?
Use 43820 when the gastrojejunostomy is performed without vagotomy. When vagotomy is performed with the gastrojejunostomy, 43825 is the corresponding code.
How does this differ from gastroduodenostomy?
Code 43820 describes a connection from the stomach to the jejunum. Code 43810 describes a connection from the stomach to the duodenum.
Does 43820 cover postoperative visits?
Medicare assigns a 90-day global period. It includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
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.
5,29743775,,Lap sleeve gastrectomy,A,,19.87,4.81,NA,4.81,,5.26,29.94,29.94,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29843800,,Pyloroplasty,A,,15.04,7.30,NA,7.30,,3.74,26.08,26.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29943810,,Gastroduodenostomy,A,,16.46,7.76,NA,7.76,,4.40,28.62,28.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30043820,,Gastrojejunostomy wo vagotmy,A,,21.97,10.11,NA,10.11,,5.54,37.62,37.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30143825,,Gastrojejunostomy w/vagotomy,A,,21.22,9.94,NA,9.94,,5.68,36.84,36.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30243830,,Gstrst open wo constj tube,A,,10.58,6.98,NA,6.98,,2.68,20.24,20.24,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30343831,,Gastrostomy open neonatal,A,,8.28,7.45,NA,7.45,,2.20,17.93,17.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915