No office rate
43644 describes laparoscopic Roux-en-Y gastric bypass. Choose 43645 when the operation also reconstructs the small intestine to limit absorption.
On this page
CMS RVU26D · Effective 2026-10-01
43645 Gastric bypass Medicare reimbursement rates in Kentucky
Reports laparoscopic gastric bypass with small-intestine reconstruction intended to limit absorption, rather than a standard Roux-en-Y bypass alone. Compare 43645 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 43645 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
$1648.44
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.
Bariatric surgery
About 43645: Laparoscopic gastric bypass with intestinal reconstruction
Reports laparoscopic gastric bypass with small-intestine reconstruction intended to limit absorption, rather than a standard Roux-en-Y bypass alone.
A bariatric surgeon performs this laparoscopically to create a gastric bypass and reconstruct the small intestine in a way intended to limit nutrient absorption. It represents a more extensive intestinal reconstruction than a standard laparoscopic Roux-en-Y gastric bypass. The operation is typically performed in a hospital or other surgical facility for treatment of severe obesity; the operative report should identify the bypass and intestinal reconstruction performed.
Select this code when the documented laparoscopic operation includes both gastric bypass and the small-intestine reconstruction to limit absorption. A standard Roux-en-Y bypass without that reconstruction is reported with 43644. 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 the others are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 43645
- 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 RVU30.74 · 60%
- Practice expense (office) RVU12.59 · 24%
- Malpractice RVU8.11 · 16%
218
Medicare services in 2024 · #4253 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.
43645 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Both describe gastric bypass with intestinal reconstruction to limit absorption, but 43847 is the open approach; 43645 is laparoscopic.
43659
No office rateUnlisted laps px stomach
43659 is an unlisted laparoscopic stomach procedure. Use 43645 when the documented bypass and intestinal reconstruction match its defined service.
Compare 43645 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
$1648.44
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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 43645 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,276
- Code
- 43645
- Physician work
- 30.74
- Practice expense
- 12.59
- Malpractice
- 8.11
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 30.74 | × 1.000 | 30.7400 |
| Practice expense | 12.59 | × 0.889 | 11.1925 |
| Malpractice | 8.11 | × 0.915 | 7.4207 |
| Total RVUs | 49.3532 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1648.44
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 30.74 | 1 |
| Practice expense | 12.59 | 0.889 |
| Malpractice | 8.11 | 0.915 |
(30.74 × 1 + 12.59 × 0.889 + 8.11 × 0.915) × $33.4009 = $1648.44
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.
43645 billing questions
How is 43645 distinguished from 43644?
Use 43645 when the laparoscopic gastric bypass includes small-intestine reconstruction intended to limit absorption. Code 43644 describes the laparoscopic Roux-en-Y bypass.
What operative documentation supports 43645?
The operative report should describe the laparoscopic approach, gastric bypass, and the small-intestine reconstruction that limits absorption. A statement that bariatric bypass was performed alone does not establish those details.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical global package.
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 subject to a 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. 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.
5,27343640,,Vagotomy & pylorus repair,A,,19.07,9.42,NA,9.42,,5.09,33.58,33.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27443641,,Vagotomy & pylorus repair,A,,19.31,9.48,NA,9.48,,5.15,33.94,33.94,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27543644,,Lap gastric bypass/roux-en-y,A,,28.67,12.14,NA,12.14,,7.64,48.45,48.45,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27643645,,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
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