No office rate
Use 43651 for placement or replacement of the vagal array; 43652 describes revision or removal of an existing array.
On this page
CMS RVU26D · Effective 2026-10-01
43651 Vagal electrode placement Medicare reimbursement rates in Iowa
Reports laparoscopic placement or replacement of a neurostimulator electrode array at the vagus nerve for gastric neuromodulation. Compare 43651 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 43651 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
$562.61
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.
Laparoscopic surgery
About 43651: Laparoscopic vagal electrode implantation
Reports laparoscopic placement or replacement of a neurostimulator electrode array at the vagus nerve for gastric neuromodulation.
This procedure places or replaces a neurostimulator electrode array at the vagus nerve using a laparoscopic approach. A surgeon performs it in an operating room, typically in a hospital or ambulatory surgical setting, for a patient whose treatment plan calls for gastric neuromodulation through vagal stimulation. The operative report should identify the electrode target and document the laparoscopic placement or replacement performed.
Report this code for the vagal electrode procedure, not for antral electrode work or for revision or removal of a previously placed vagal array. The code has a 90-day global period: the day-before preoperative visit and related postoperative care during the 90 days are included. 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% multiple-procedure reduction. Bilateral adjustment is not appropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43651
- 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 RVU9.88 · 52%
- Practice expense (office) RVU6.47 · 34%
- Malpractice RVU2.63 · 14%
40
Medicare services in 2024 · #5501 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.
43651 compared with similar codes
Office rates for Iowa, from the same CMS release.
43647
No office rateLap impl electrode antrum
Both involve laparoscopic gastric neurostimulator electrode procedures, but 43647 addresses electrodes placed at the antrum rather than the vagus nerve.
43648
No office rateLap revise/remv eltrd antrum
43648 covers revision or removal of antral electrodes. It is not the code for placing or replacing a vagal electrode array.
No office rate
43640 reports laparoscopic vagotomy without a drainage procedure. It describes cutting vagal nerve supply, not implanting a neurostimulator electrode array.
Compare 43651 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
$562.61
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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 43651 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,279
- Code
- 43651
- Physician work
- 9.88
- Practice expense
- 6.47
- Malpractice
- 2.63
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.88 | × 1.000 | 9.8800 |
| Practice expense | 6.47 | × 0.915 | 5.9200 |
| Malpractice | 2.63 | × 0.397 | 1.0441 |
| Total RVUs | 16.8442 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$562.61
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.88 | 1 |
| Practice expense | 6.47 | 0.915 |
| Malpractice | 2.63 | 0.397 |
(9.88 × 1 + 6.47 × 0.915 + 2.63 × 0.397) × $33.4009 = $562.61
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.
43651 billing questions
How is this different from 43652?
43651 is for laparoscopic placement or replacement of the vagal electrode array. Use 43652 for revision or removal of a previously placed vagal array.
How is this different from 43647?
43651 targets the vagus nerve. Code 43647 is for gastric neurostimulator electrode work at the antrum.
Does the 90-day global period include postoperative visits?
Related postoperative care during the 90 days is included, as is the day-before preoperative visit.
Can an assistant surgeon be reported?
Assistant-at-surgery payment may be available for this procedure. Co-surgeon payment requires supporting documentation.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard 50% multiple-procedure reduction.
Should modifier 50 be used for bilateral placement?
No. Bilateral adjustment is inappropriate for this code’s descriptor and anatomy.
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.
5,27643645,,Lap gastr bypass incl smll i,A,,30.74,12.59,NA,12.59,,8.11,51.44,51.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27743647,,Lap impl electrode antrum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27843648,,Lap revise/remv eltrd antrum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27943651,,Laparoscopy vagus nerve,A,,9.88,6.47,NA,6.47,,2.63,18.98,18.98,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28043652,,Laparoscopy vagus nerve,A,,11.83,6.94,NA,6.94,,3.16,21.93,21.93,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28143653,,Laparoscopy gastrostomy,A,,8.27,6.49,NA,6.49,,2.16,16.92,16.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,28243659,,Unlisted laps px stomach,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,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