No office rate
43631 describes a primary distal partial gastrectomy with gastroduodenostomy. Code 43635 is an add-on and should not replace the primary code.
On this page
CMS RVU26D · Effective 2026-10-01
43635 Partial gastrectomy Medicare reimbursement rates in Massachusetts
This add-on reports partial removal of the stomach when performed with a qualifying primary procedure during the same operative service. Compare 43635 office and facility rates across CMS payment localities in Massachusetts.
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 43635 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$99.20–$104.79
2 of 2 localities have a supported rate.
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 43635: Add-on partial stomach resection
This add-on reports partial removal of the stomach when performed with a qualifying primary procedure during the same operative service.
CPT 43635 represents partial removal of stomach tissue as an additional operative service accompanying a primary procedure. A surgeon may perform partial stomach resection during an operation when the documented surgical plan requires removal of only part of the stomach. The code identifies the resection service; the primary procedure and the operative details establish the broader surgical context.
Report 43635 only with a primary procedure that permits this add-on, and document the portion of stomach removed and how the work relates to the primary operation. It is not a stand-alone code. CMS treats payment for the add-on as part of the primary procedure’s global period, so the add-on is paid within that period. The primary code should reflect the operation performed; codes 43631–43634 distinguish partial gastrectomy procedures by location and reconstruction.
CMS billing rules for 43635
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.01 · 67%
- Practice expense (office) RVU0.48 · 16%
- Malpractice RVU0.53 · 18%
50
Medicare services in 2024 · #5356 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.
43635 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
43633 describes a primary distal partial gastrectomy with Roux-en-Y reconstruction. Select the primary code from the documented operation and use 43635 only as an eligible add-on.
No office rate
43610 describes excision of a stomach lesion. Use the code that matches the documented service; 43635 represents partial stomach removal as an add-on.
No office rate
43620 represents total rather than partial stomach removal. The operative report should establish whether the stomach was removed in part or in its entirety.
Compare 43635 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$104.79
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$99.20
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43635 billing questions
Can 43635 be reported by itself?
No. It is an add-on code and must be reported with a qualifying primary procedure.
How is 43635 different from 43631–43634?
Codes 43631–43634 describe primary partial gastrectomy procedures, with distinctions based on location and reconstruction. Code 43635 is an add-on, not a substitute for those primary procedure codes.
What documentation supports reporting 43635?
The operative report should identify the partial stomach resection performed and explain its relationship to the primary operation.
How does the global period affect payment?
CMS pays 43635 within the global period of the primary procedure. Report it only with that primary procedure.
Should 43635 replace a code for excision of a stomach lesion?
Not based on the short descriptor alone. Distinguish partial stomach resection from lesion excision using the documented extent and nature of the operation.
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.
5,26943632,,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
5,27043633,,Removal of stomach partial,A,,32.31,12.65,NA,12.65,,8.21,53.17,53.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27143634,,Removal of stomach partial,A,,35.72,13.45,NA,13.45,,9.57,58.74,58.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27243635,,Removal of stomach partial,A,,2.01,0.48,NA,0.48,,0.53,3.02,3.02,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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