CPT code 43800: Pyloroplasty2026 Medicare rate & RVUs in Massachusetts
Reports surgical enlargement of the pyloric outlet, commonly to improve gastric emptying when narrowing obstructs passage from the stomach.
CMS doesn’t publish an office rate for 43800 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43800 covers
A surgeon enlarges the pyloric channel, the outlet between the stomach and duodenum, by surgically opening and reconstructing the area to improve passage of stomach contents. The procedure may be performed for gastric outlet narrowing, including narrowing associated with peptic ulcer disease, or as a drainage procedure during gastric surgery. It is typically performed in an operating room by a general or gastrointestinal surgeon.
Report 43800 when the operative work is pyloroplasty, rather than creation of a bypass or a stomach-to-duodenum connection. The operative report should identify the pylorus as the site and describe the incision and reconstruction that widen the outlet. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
Where 43800 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | Unavailable | $925.25 |
| Rest Of Massachusetts | Unavailable | $866.70 |
How the 43800 rate is calculated
Each of 43800’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43800
RVUs × geographic indexes × conversion factor
Work15.04
15.04 RVUs× 1.000 GPCI
Practice expense7.30
7.30 RVUs× 1.000 GPCI
Malpractice3.74
3.74 RVUs× 1.000 GPCI
Adjusted RVUs
26.0800
Conversion factor
$33.4009
Medicare rate
$871.10
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43800
43800 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43800
Pyloroplasty
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43800
Pyloroplasty
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43800 without 51 · national facility
$871.10
Pyloroplasty
43800-51 · Second procedure: 50%
$435.55
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43800 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43810Gastroduodenostomy
- Choose 43800 for surgical widening of the pylorus. Choose 43810 when the surgeon creates a direct connection between the stomach and duodenum.
- 43820Gastrojejunostomy
- 43800 enlarges the existing gastric outlet. 43820 creates a gastrojejunostomy, routing stomach contents to the jejunum.
- 43825Gastrojejunostomy
- 43825 describes a gastrojejunostomy performed with vagotomy. It is not the code for widening the pyloric outlet.
43800 billing questions
How does pyloroplasty differ from gastroduodenostomy?
Pyloroplasty widens the existing pyloric outlet. Gastroduodenostomy creates a connection between the stomach and duodenum.
Is related postoperative care separately reported during the global period?
The 90-day global period includes related postoperative care and the day-before preoperative visit. Report a separate service only when the circumstances support separate reporting under applicable coding rules.
How is 43800 affected when another procedure is performed in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.
What documentation supports reporting pyloroplasty?
The operative report should identify work on the pylorus and describe how the outlet was surgically widened. Documentation of a bypass or a different reconstruction supports consideration of the code for that procedure instead.
Can an assistant or co-surgeon be reported?
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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