No office rate
48150 represents a conventional Whipple-type resection that includes partial removal of the stomach. Choose 48154 when the operative note documents a pylorus-preserving pancreaticoduodenectomy with pancreatic reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
48154 Pancreaticoduodenectomy Medicare reimbursement rates in Kentucky
Reports a pylorus-preserving Whipple-type operation that removes the pancreatic head and duodenum while reconnecting the remaining pancreas to the intestine. Compare 48154 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 48154 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
$2574.24
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.
Pancreatic surgery
About 48154: Pylorus-preserving pancreaticoduodenectomy with pancreatic reconstruction
Reports a pylorus-preserving Whipple-type operation that removes the pancreatic head and duodenum while reconnecting the remaining pancreas to the intestine.
This operation removes the proximal portion of the pancreas and the duodenum while preserving the pylorus, the stomach’s outlet. The surgeon reconnects the remaining pancreas to the intestine and restores the digestive tract after resection. A pancreatic surgeon typically performs it in a hospital for selected tumors of the pancreatic head or periampullary region. Unlike a conventional Whipple operation that removes part of the stomach, the pylorus-preserving approach retains the gastric outlet.
Report 48154 when the operative note supports the pylorus-preserving resection and pancreatic-to-intestinal reconstruction. The note should identify the structures removed, preservation of the pylorus, and the connections created. Medicare treats it as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50% under the standard multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation. Team surgery is not permitted.
CMS billing rules for 48154
- 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 RVU47.66 · 59%
- Practice expense (office) RVU19.95 · 25%
- Malpractice RVU12.76 · 16%
34
Medicare services in 2024 · #5586 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.
48154 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Both are proximal pancreatic resection variants. Use the operative report’s account of stomach removal or pylorus preservation and the reconstruction performed to distinguish them.
No office rate
48155 involves removal of the entire pancreas. Code 48154 describes a proximal subtotal resection that leaves pancreatic tissue for reconstruction.
Compare 48154 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
$2574.24
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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 48154 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,744
- Code
- 48154
- Physician work
- 47.66
- Practice expense
- 19.95
- Malpractice
- 12.76
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 47.66 | × 1.000 | 47.6600 |
| Practice expense | 19.95 | × 0.889 | 17.7355 |
| Malpractice | 12.76 | × 0.915 | 11.6754 |
| Total RVUs | 77.0709 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$2574.24
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 47.66 | 1 |
| Practice expense | 19.95 | 0.889 |
| Malpractice | 12.76 | 0.915 |
(47.66 × 1 + 19.95 × 0.889 + 12.76 × 0.915) × $33.4009 = $2574.24
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.
48154 billing questions
How is 48154 distinguished from a conventional Whipple procedure?
Look for preservation of the pylorus and no partial gastrectomy. The operative report should also document the pancreatic-to-intestinal connection.
Can the pancreatic reconstruction be billed separately?
The pancreatic-to-intestinal reconstruction is part of the operation represented by 48154; do not separately report that connection as another pancreaticoduodenectomy.
Is modifier 50 appropriate for this operation?
No. The pancreas is not treated as a paired organ for a bilateral adjustment under this code.
How are other procedures in the same operative session paid?
The standard multiple-procedure reduction pays the highest-valued procedure in full and other procedures at 50%.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons require documentation supporting their distinct roles; 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.
5,74148150,,Partial removal of pancreas,A,,51.52,21.52,NA,21.52,,12.92,85.96,85.96,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74248152,,Pancreatectomy,A,,47.43,19.90,NA,19.90,,12.70,80.03,80.03,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74348153,,Pancreatectomy,A,,51.47,20.90,NA,20.90,,13.34,85.71,85.71,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74448154,,Pancreatectomy,A,,47.66,19.95,NA,19.95,,12.76,80.37,80.37,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74548155,,Removal of pancreas,A,,28.71,15.24,NA,15.24,,7.29,51.24,51.24,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,74648160,,Pancreas removal/transplant,N,,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
5,74748400,,Injection intraop add-on,A,,1.90,0.46,NA,0.46,,0.49,2.85,2.85,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,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