Billing code 43640: VagotomyMedicare rate & RVUs in Ohio
Report this open abdominal operation when a surgeon divides vagal nerve branches and performs pyloroplasty to improve gastric drainage.
CMS doesn’t publish an office rate for 43640 in Ohio.
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 43640 covers
This operation combines a truncal or selective vagotomy, which reduces vagal stimulation of gastric acid secretion, with pyloroplasty to widen the pyloric outlet and improve stomach emptying. A surgeon typically performs it through an abdominal incision for a patient whose treatment requires both steps, such as selected cases of complicated or refractory peptic ulcer disease. The code represents the combined operation, not vagotomy alone or pyloroplasty alone.
Report it when the operative note supports both the vagotomy and the pyloroplasty; document the approach, nerve division performed, and drainage procedure. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. An assistant at surgery 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.
43640 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $1,095.59 |
How the 43640 rate is calculated
Each of 43640’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 · 43640
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 19.07Practice expense 9.42Malpractice 5.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43640
43640 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43640
Vagotomy
| 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 · 43640
Vagotomy
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
43640 without 51 · national facility
$1,121.60
Vagotomy
43640-51 · Second procedure: 50%
$560.80
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%).
43640 compared with similar codes
Compare codes
43640 vs 43641 vs 43651 vs 43652: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43641Vagotomy
- Choose 43640 when pyloroplasty accompanies vagotomy. Choose 43641 when antrectomy accompanies vagotomy, with or without gastroduodenostomy.
- 43651Vagal electrode placement
- 43651 describes laparoscopic vagotomy without a drainage procedure. 43640 includes pyloroplasty with the vagotomy.
- 43652Vagotomy
- 43652 describes laparoscopic vagotomy with a drainage procedure; 43640 represents the corresponding combined operation by an open approach.
43640 billing questions
What distinguishes 43640 from 43641?
43640 includes pyloroplasty with the vagotomy. 43641 is used for vagotomy with antrectomy, with or without gastroduodenostomy.
Is pyloroplasty separately reported with 43640?
Pyloroplasty is part of the combined service represented by 43640. The operative note should establish that the drainage procedure was performed.
How does 43640 differ from laparoscopic vagotomy codes?
43640 describes the operation with pyloroplasty, generally performed through an open approach. For a laparoscopic vagotomy with a drainage procedure, compare 43652.
Can an assistant surgeon be reported?
An assistant at surgery may be paid for 43640. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Should modifier 50 be used for a bilateral operation?
No. Modifier 50 is inappropriate for this procedure and anatomy.
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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