Billing code 43846: Gastric bypassMedicare rate & RVUs in Nevada
Reports open bariatric gastric bypass creating a small stomach pouch and a short Roux-en-Y connection for treatment of morbid obesity.
CMS doesn’t publish an office rate for 43846 in Nevada.
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 43846 covers
The surgeon creates a small stomach pouch and connects it to the small intestine using a Roux-en-Y configuration with a short Roux limb, under 150 cm. This open bariatric operation is performed for morbid obesity, typically by a bariatric or general surgeon in a hospital operating room. The operative report should establish the bypass anatomy and limb length; the short-limb configuration distinguishes this service from longer intestinal reconstruction and other bariatric procedures.
Report the code when the operation performed matches this open short-limb bypass, rather than selecting it solely because the patient underwent bariatric surgery. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery services may be paid; 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.
43846 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $1,507.94 |
How the 43846 rate is calculated
Each of 43846’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 · 43846
RVUs × geographic indexes × conversion factor
Work26.72
26.72 RVUs× 1.000 GPCI
Practice expense12.45
12.45 RVUs× 1.000 GPCI
Malpractice7.16
7.16 RVUs× 1.000 GPCI
Adjusted RVUs
46.3300
Conversion factor
$33.4009
Medicare rate
$1,547.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43846
43846 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43846
Gastric bypass
| 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 · 43846
Gastric bypass
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
43846 without 51 · national facility
$1,547.46
Gastric bypass
43846-51 · Second procedure: 50%
$773.73
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%).
43846 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43644Gastric bypass
- Use 43644 for the laparoscopic gastric bypass with Roux-en-Y reconstruction. This code describes the open approach.
- 43847Bariatric surgery
- Choose this code for the short-limb Roux-en-Y configuration. Code 43847 describes bypass with additional small-intestinal reconstruction to limit absorption.
- 43845Duodenal switch
- Code 43845 describes a duodenal-switch reconstruction, not the short-limb Roux-en-Y gastric bypass reported here.
- 43848Bariatric revision
- Code 43848 describes revision of an open gastric restrictive procedure. It is not the code for the primary short-limb bypass operation.
43846 billing questions
How does this differ from 43847?
This code describes a short Roux limb under 150 cm. Code 43847 is for gastric bypass with additional small-intestinal reconstruction to limit absorption.
Can this be reported for a laparoscopic bypass?
No. For a laparoscopic gastric bypass with Roux-en-Y reconstruction, compare 43644. This code describes the open operation.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
Can an assistant surgeon be paid?
CMS allows payment for assistant-at-surgery services. Co-surgeon payment requires supporting documentation.
What documentation supports choosing this code?
The operative report should describe the gastric pouch, Roux-en-Y anatomy, open approach, and short limb length. These details distinguish it from longer-limb reconstruction and other bariatric procedures.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard 50% multiple-procedure reduction to the other procedures.
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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