No office rate
Use 43500 for gastric exploration or biopsy through an operative opening. Choose 43501 when the documented procedure is gastric repair.
On this page
CMS RVU26D · Effective 2026-10-01
43500 Gastrotomy Medicare reimbursement rates in Iowa
Report this service when a surgeon opens the stomach during an operation to inspect it or obtain one or more gastric biopsies. Compare 43500 office and facility rates across CMS payment localities in Iowa.
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 43500 in Iowa?
Iowa 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
$667.12
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Gastric surgery
About 43500: Gastrotomy with exploration or biopsy
Report this service when a surgeon opens the stomach during an operation to inspect it or obtain one or more gastric biopsies.
A surgeon makes an operative opening in the stomach to examine its interior or take biopsy tissue. General surgeons typically perform this procedure in a hospital operating room as part of abdominal surgery when direct access to the stomach is needed; it is not an endoscopic biopsy. The code covers exploration or one or more biopsies through the gastrotomy.
Choose the code when the operative record documents the gastric incision and its exploratory or biopsy purpose. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this procedure.
CMS billing rules for 43500
- 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 RVU12.47 · 55%
- Practice expense (office) RVU6.79 · 30%
- Malpractice RVU3.25 · 14%
144
Medicare services in 2024 · #4596 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.
43500 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
43500 describes opening the stomach for inspection or biopsy; 43502 is a gastric repair service.
No office rate
Both involve an operative gastric opening, but 43500 is selected for exploration or biopsy; use 43510 when its distinct procedure is performed.
No office rate
43520 involves incision of the pyloric muscle, rather than opening the stomach for exploration or biopsy.
Compare 43500 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
Iowa →
Office / nonfacility
Unavailable
Facility
$667.12
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 43500 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,256
- Code
- 43500
- Physician work
- 12.47
- Practice expense
- 6.79
- Malpractice
- 3.25
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.47 | × 1.000 | 12.4700 |
| Practice expense | 6.79 | × 0.915 | 6.2129 |
| Malpractice | 3.25 | × 0.397 | 1.2903 |
| Total RVUs | 19.9731 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$667.12
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.47 | 1 |
| Practice expense | 6.79 | 0.915 |
| Malpractice | 3.25 | 0.397 |
(12.47 × 1 + 6.79 × 0.915 + 3.25 × 0.397) × $33.4009 = $667.12
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.
43500 billing questions
When should 43500 be reported instead of a gastric repair code?
Report 43500 when the stomach is opened for exploration or biopsy. A procedure whose purpose is to repair a gastric defect or lesion belongs to the applicable repair code instead.
Does 43500 cover multiple gastric biopsies?
Yes. The service includes one or more biopsies taken through the gastrotomy; do not report additional units of 43500 just for additional biopsy samples.
Can modifier 50 be used for a gastrotomy?
No. Modifier 50 is inappropriate for this procedure.
How does the 90-day global period affect billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session handled?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and 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 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.
5,25343496,,Free jejunum flap microvasc,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25443497,,Transorl lwr esophgl myotomy,A,,12.96,6.75,NA,6.75,,1.80,21.51,21.51,0,090,0.09,0.81,0.10,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,25543499,,Unlisted procedure esophagus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25643500,,Surgical opening of stomach,A,,12.47,6.79,NA,6.79,,3.25,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25743501,,Surgical repair of stomach,A,,22.04,10.11,NA,10.11,,5.83,37.98,37.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25843502,,Surgical repair of stomach,A,,25.05,10.87,NA,10.87,,6.69,42.61,42.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2594350F,,Cnslng provided symp mngmnt,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136