No office rate
Use 43845 for the pylorus-preserving duodenal switch with duodenoileal and ileoileal connections. Use 43846 for the short-limb Roux-en-Y gastric bypass configuration.
On this page
CMS RVU26D · Effective 2026-10-01
43845 Duodenal switch Medicare reimbursement rates in Indiana
Reports bariatric surgery combining partial stomach removal with preserved pyloric passage and intestinal rerouting through duodenoileal and ileoileal connections. Compare 43845 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 43845 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
$1646.59
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.
Bariatric surgery
About 43845: Pylorus-preserving duodenal switch
Reports bariatric surgery combining partial stomach removal with preserved pyloric passage and intestinal rerouting through duodenoileal and ileoileal connections.
This operation combines removal of part of the stomach with intestinal rerouting while preserving the pylorus. The surgeon connects the duodenum to the ileum and creates a second intestinal connection, changing how food and digestive secretions travel through the bowel. It is performed by a bariatric or gastrointestinal surgeon, typically in a hospital operating room, as a weight-loss procedure for a patient with severe obesity.
Choose this code when the operative report supports the pylorus-preserving duodenal-switch anatomy, including the partial gastrectomy and both intestinal connections; the label “bariatric surgery” alone is not enough. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures 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 not appropriate for this single reconstructive operation. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 43845
- 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 RVU32.47 · 59%
- Practice expense (office) RVU13.66 · 25%
- Malpractice RVU8.57 · 16%
254
Medicare services in 2024 · #4128 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.
43845 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Code 43847 describes gastric restriction with intestinal reconstruction to limit absorption, but not the specific pylorus-preserving duodenal-switch anatomy reported with 43845.
No office rate
Code 43843 represents another restrictive gastric procedure, rather than the partial gastrectomy and two intestinal connections that define the duodenal switch.
Compare 43845 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
$1646.59
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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 43845 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,308
- Code
- 43845
- Physician work
- 32.47
- Practice expense
- 13.66
- Malpractice
- 8.57
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 32.47 | × 1.000 | 32.4700 |
| Practice expense | 13.66 | × 0.927 | 12.6628 |
| Malpractice | 8.57 | × 0.486 | 4.1650 |
| Total RVUs | 49.2978 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$1646.59
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 32.47 | 1 |
| Practice expense | 13.66 | 0.927 |
| Malpractice | 8.57 | 0.486 |
(32.47 × 1 + 13.66 × 0.927 + 8.57 × 0.486) × $33.4009 = $1646.59
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.
43845 billing questions
How is this different from code 43846?
This code describes a pylorus-preserving duodenal switch with duodenoileal and ileoileal connections. Code 43846 describes a gastric bypass using a short-limb Roux-en-Y reconstruction.
What operative details support reporting this code?
The operative report should establish partial gastrectomy with preservation of the pylorus and the duodenoileal and ileoileal connections. A general reference to bariatric surgery does not establish this specific reconstruction.
Is modifier 50 appropriate?
No. The procedure is a single reconstructive operation, not a bilateral service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
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 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.
5,30543840,,Gstrrphy sutr duol/gstr ulcr,A,,22.26,10.11,NA,10.11,,5.73,38.10,38.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30643842,,Gstr rstcv px v-banded gstp,N,+,20.50,7.80,NA,7.80,,2.19,30.49,30.49,9,090,0.09,0.81,0.10,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30743843,,Gstr rstcv oth/thn v-band,A,,20.68,9.91,NA,9.91,,5.53,36.12,36.12,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30843845,,Gastroplasty duodenal switch,A,,32.47,13.66,NA,13.66,,8.57,54.70,54.70,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30943846,,Gstr rstcv px shrt roux-en-y,A,,26.72,12.45,NA,12.45,,7.16,46.33,46.33,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31043847,,Gstr rstcv px sm int rcnstj,A,,29.52,13.12,NA,13.12,,7.90,50.54,50.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31143848,,Revj open gstr rstcv px,A,,31.93,13.40,NA,13.40,,8.32,53.65,53.65,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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