No office rate
Both describe total stomach removal; 43621 includes Roux-en-Y reconstruction, while 43620 is for total gastrectomy without that reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
43621 Total gastrectomy Medicare reimbursement rates in Iowa
Report this service for complete stomach removal followed by Roux-en-Y reconstruction, commonly performed for gastric malignancy or other disease requiring total gastrectomy. Compare 43621 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 43621 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
$1853.99
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 43621: Total gastrectomy with Roux-en-Y reconstruction
Report this service for complete stomach removal followed by Roux-en-Y reconstruction, commonly performed for gastric malignancy or other disease requiring total gastrectomy.
The operation removes the stomach in its entirety and restores continuity by connecting the esophagus to a Roux-en-Y limb of small intestine. General surgeons and surgical oncologists perform it in an operating room, commonly for gastric cancer or other disease requiring complete removal. The documented reconstruction distinguishes this service from total gastrectomy without that configuration or with an intestinal pouch.
Report the code when the operative record supports both complete stomach removal and Roux-en-Y reconstruction; a partial resection or lesion excision is not enough. This major surgery has a 90-day global period, including 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 50% reduction. Modifier 50 is inappropriate for this single-organ procedure. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 43621
- 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 RVU38.54 · 62%
- Practice expense (office) RVU14.30 · 23%
- Malpractice RVU9.78 · 16%
291
Medicare services in 2024 · #4018 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.
43621 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
This code is for total gastrectomy with Roux-en-Y reconstruction. Choose 43622 when the operation forms an intestinal pouch instead.
No office rate
43631 represents partial stomach removal with gastroduodenostomy. Use 43621 only when the entire stomach is removed and the documented reconstruction is Roux-en-Y.
No office rate
43610 is for excision of a stomach lesion, not complete stomach removal. The operative extent determines which service was performed.
Compare 43621 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
$1853.99
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 43621 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,266
- Code
- 43621
- Physician work
- 38.54
- Practice expense
- 14.30
- Malpractice
- 9.78
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 38.54 | × 1.000 | 38.5400 |
| Practice expense | 14.30 | × 0.915 | 13.0845 |
| Malpractice | 9.78 | × 0.397 | 3.8827 |
| Total RVUs | 55.5072 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1853.99
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 38.54 | 1 |
| Practice expense | 14.3 | 0.915 |
| Malpractice | 9.78 | 0.397 |
(38.54 × 1 + 14.3 × 0.915 + 9.78 × 0.397) × $33.4009 = $1853.99
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.
43621 billing questions
How is this distinguished from 43620?
Use 43621 when the total gastrectomy includes Roux-en-Y reconstruction. Code 43620 describes total gastrectomy without that reconstruction.
When is 43622 a better fit?
Use 43622 when the total gastrectomy includes formation of an intestinal pouch. The reconstruction documented in the operative report determines the choice.
Can a partial gastrectomy be reported with this code?
No. This code represents removal of the entire stomach; a resection that leaves part of the stomach is represented by an appropriate partial-gastrectomy code.
Should modifier 50 be used?
No. The code represents removal of a single stomach, so modifier 50 is inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment 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.
5,26343610,,Excision of stomach lesion,A,,15.93,7.54,NA,7.54,,4.07,27.54,27.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26443611,,Excision of stomach lesion,A,,19.87,9.57,NA,9.57,,4.96,34.40,34.40,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26543620,,Removal of stomach,A,,33.19,12.84,NA,12.84,,8.89,54.92,54.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26643621,,Removal of stomach,A,,38.54,14.30,NA,14.30,,9.78,62.62,62.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26743622,,Removal of stomach,A,,39.03,14.26,NA,14.26,,10.46,63.75,63.75,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26843631,,Removal of stomach partial,A,,23.90,10.55,NA,10.55,,6.14,40.59,40.59,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26943632,,Removal of stomach partial,A,,34.26,13.17,NA,13.17,,8.72,56.15,56.15,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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