No office rate
43605 represents tissue sampling for diagnosis. Choose 43610 when the service is excision of a stomach lesion rather than biopsy alone.
On this page
CMS RVU26D · Effective 2026-10-01
43605 Stomach biopsy Medicare reimbursement rates in Kentucky
An open abdominal gastric biopsy obtains tissue for diagnosis when the surgeon samples the stomach during laparotomy rather than using a peroral approach. Compare 43605 office and facility rates across CMS payment localities in Kentucky.
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 43605 in Kentucky?
Kentucky 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
$764.47
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 43605: Open surgical stomach biopsy
An open abdominal gastric biopsy obtains tissue for diagnosis when the surgeon samples the stomach during laparotomy rather than using a peroral approach.
Code 43605 represents diagnostic tissue sampling of the stomach through an open abdominal incision. The surgeon exposes the stomach during laparotomy and removes a specimen for histologic evaluation, such as when an abnormal area requires tissue diagnosis and open access is the approach used. This is an operative biopsy, not an excision intended to remove a gastric lesion as treatment. General or gastrointestinal surgeons typically perform the service in an operating room.
Report the code when the operative record supports an open approach and gastric tissue sampling. Document the indication, sampled site, findings, and specimen submitted. CMS assigns 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 reduced to 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43605
- 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 RVU13.38 · 56%
- Practice expense (office) RVU7.01 · 29%
- Malpractice RVU3.58 · 15%
110
Medicare services in 2024 · #4809 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.
43605 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$65.08
88305 represents the pathology examination of a specimen. Code 43605 represents the surgeon’s operative procurement of gastric tissue.
Compare 43605 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$764.47
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 43605 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,262
- Code
- 43605
- Physician work
- 13.38
- Practice expense
- 7.01
- Malpractice
- 3.58
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.38 | × 1.000 | 13.3800 |
| Practice expense | 7.01 | × 0.889 | 6.2319 |
| Malpractice | 3.58 | × 0.915 | 3.2757 |
| Total RVUs | 22.8876 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$764.47
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.38 | 1 |
| Practice expense | 7.01 | 0.889 |
| Malpractice | 3.58 | 0.915 |
(13.38 × 1 + 7.01 × 0.889 + 3.58 × 0.915) × $33.4009 = $764.47
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.
43605 billing questions
How does 43605 differ from 43600?
43605 is for gastric tissue sampling through an open abdominal approach. Code 43600 describes biopsy by mouth.
When is 43610 a better choice?
Use 43605 for diagnostic tissue sampling. Code 43610 is for excision of a stomach lesion rather than a biopsy alone.
What documentation supports 43605?
The operative report should establish the open approach, the reason for sampling, the stomach site sampled, and the tissue obtained.
Are related postoperative visits included?
Yes. 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 is not permitted for this code.
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.
5,2594350F,,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
5,26043510,,Surgical opening of stomach,A,,14.76,8.37,NA,8.37,,3.93,27.06,27.06,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26143520,,Incision of pyloric muscle,A,,11.01,6.44,NA,6.44,,2.94,20.39,20.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26243605,,Biopsy of stomach,A,,13.38,7.01,NA,7.01,,3.58,23.97,23.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26343610,,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
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631