No office rate
43500 describes gastrotomy for exploration or foreign body removal. Choose 43510 when the gastrotomy is used for perforated ulcer repair.
On this page
CMS RVU26D · Effective 2026-10-01
43510 Gastrotomy Medicare reimbursement rates in Michigan
Open gastric access with repair of a perforated ulcer is reported when the surgeon enters the stomach to perform the ulcer repair. Compare 43510 office and facility rates across CMS payment localities in Michigan.
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 43510 in Michigan?
Michigan 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
$896.44–$984.09
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 43510: Gastrotomy with perforated ulcer repair
Open gastric access with repair of a perforated ulcer is reported when the surgeon enters the stomach to perform the ulcer repair.
This code describes an open operation in which the surgeon makes an incision into the stomach to access and repair a perforated ulcer. It is a major abdominal procedure typically performed by a general or gastrointestinal surgeon in a hospital operating room. The operative report should identify the perforation, the gastric access and repair performed, and any associated procedures.
Report the code for the gastrotomy-based repair, rather than for exploration, biopsy, or repair of a bleeding ulcer alone. 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 multiple procedure reduction. Modifier 50 is inappropriate for this single-organ procedure. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43510
- 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 RVU14.76 · 55%
- Practice expense (office) RVU8.37 · 31%
- Malpractice RVU3.93 · 15%
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.
43510 compared with similar codes
Office rates for Michigan, from the same CMS release.
No office rate
43501 is for gastric biopsy through a gastrotomy. It does not describe repair of a perforated ulcer.
No office rate
43502 addresses suture repair of a bleeding ulcer; 43510 is associated with perforation.
No office rate
43840 describes direct suture repair of a perforated gastric or duodenal ulcer, wound, or injury. Distinguish it by the operation documented and whether the gastrotomy-based service represented by 43510 was performed.
Compare 43510 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
Detroit →
Office / nonfacility
Unavailable
Facility
$984.09
Rest Of Michigan →
Office / nonfacility
Unavailable
Facility
$896.44
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43510 billing questions
How is this code different from 43500?
Use 43510 for gastrotomy-based repair of a perforated ulcer. Code 43500 describes gastrotomy for exploration or foreign body removal.
Is this the code for repairing a bleeding ulcer?
No. Code 43502 is the related gastrotomy code for suture repair of a bleeding ulcer; 43510 is for a perforated ulcer.
What documentation supports reporting 43510?
The operative report should establish the perforated ulcer and describe the gastric incision and repair performed. Include any separately performed procedures in the operative documentation.
Can an assistant surgeon be reported?
CMS indicates that assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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 paid at 50% when performed in the same session.
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.
5,25743501,,Surgical repair of stomach,A,,22.04,10.11,NA,10.11,,5.83,37.98,37.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25843502,,Surgical repair of stomach,A,,25.05,10.87,NA,10.87,,6.69,42.61,42.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2594350F,,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