No office rate
Use 43830 when open gastric access is created without fashioning a gastric tube from stomach tissue. Use 43832 when the surgeon constructs that tube.
On this page
CMS RVU26D · Effective 2026-10-01
43830 Gastrostomy Medicare reimbursement rates in New Jersey
Reports open surgical creation of gastric access without constructing a gastric tube, commonly for enteral feeding or stomach decompression. Compare 43830 office and facility rates across CMS payment localities in New Jersey.
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 43830 in New Jersey?
New Jersey 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
$720.30–$741.69
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 43830: Open gastrostomy without tube construction
Reports open surgical creation of gastric access without constructing a gastric tube, commonly for enteral feeding or stomach decompression.
This service creates an opening from the stomach to the abdominal wall through an open abdominal operation, without fashioning a separate gastric tube from stomach tissue. The surgeon places access for purposes such as delivering enteral nutrition or decompressing the stomach. General and pediatric surgeons typically perform it in a hospital operating room when access is needed and an open approach is selected.
Report the code when the operative note supports an open approach and confirms that the surgeon did not construct a gastric tube. Document the indication, the access created, and the tube placement or intended function. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures occur in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery payment is not permitted. Modifier 50 is inappropriate for this gastric procedure.
CMS billing rules for 43830
- 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 RVU10.58 · 52%
- Practice expense (office) RVU6.98 · 34%
- Malpractice RVU2.68 · 13%
2.9K
Medicare services in 2024 · #2206 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.
43830 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
This is the neonatal-specific open gastrostomy code. Code 43830 is not the neonatal-specific choice.
$854.20–$900.65
Code 49440 describes percutaneous tube placement with imaging guidance. Code 43830 is for creating gastric access through an open operation.
No office rate
Code 43246 uses an endoscope to guide percutaneous gastrostomy placement. Code 43830 describes an open surgical approach.
Compare 43830 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$741.69
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$720.30
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43830 billing questions
How does this differ from 43832?
Code 43830 describes open gastric access without constructing a gastric tube from stomach tissue. Code 43832 is the related open procedure that includes that construction.
When should 43831 be considered instead?
Code 43831 is the neonatal-specific open gastrostomy code. Select the code that matches the patient and the procedure documented, rather than using 43830 automatically for every open gastrostomy.
Is tube placement included in this service?
The reported service establishes gastric access for a tube, so routine placement associated with creating that access is part of the operation. The operative report should describe the access and the tube.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate because this gastric operation has no bilateral counterpart.
What should the operative note establish?
Document the clinical reason for access, the open approach, the gastric opening and tube access created, and whether a gastric tube was constructed from stomach tissue.
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.
5,29943810,,Gastroduodenostomy,A,,16.46,7.76,NA,7.76,,4.40,28.62,28.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30043820,,Gastrojejunostomy wo vagotmy,A,,21.97,10.11,NA,10.11,,5.54,37.62,37.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30143825,,Gastrojejunostomy w/vagotomy,A,,21.22,9.94,NA,9.94,,5.68,36.84,36.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30243830,,Gstrst open wo constj tube,A,,10.58,6.98,NA,6.98,,2.68,20.24,20.24,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30343831,,Gastrostomy open neonatal,A,,8.28,7.45,NA,7.45,,2.20,17.93,17.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30443832,,Gstrst open w/constj tube,A,,16.91,8.23,NA,8.23,,4.38,29.52,29.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30543840,,Gstrrphy sutr duol/gstr ulcr,A,,22.26,10.11,NA,10.11,,5.73,38.10,38.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00