Billing code 43610: Gastric lesion excisionMedicare rate & RVUs in Oklahoma
Report 43610 when a surgeon operatively removes a focal gastric lesion without performing the partial gastrectomy represented by a more extensive resection code.
CMS doesn’t publish an office rate for 43610 in Oklahoma.
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 43610 covers
A surgeon removes a localized lesion from the stomach through an operative approach, opening the stomach when needed to reach the site. A focal gastric ulcer or other localized lesion may be excised while avoiding a formal partial gastrectomy. General surgeons typically perform the procedure in a hospital operating room; Medicare claims in the supplied utilization data show facility rather than office services.
Choose this code for excision, not tissue sampling alone, and distinguish it from 43611 when the operation includes partial gastrectomy. The operative report should identify the lesion, the excision performed, and whether gastric resection was part of the procedure. 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 others at 50%. Do not append modifier 50 for this stomach procedure. 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.
43610 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $862.60 |
How the 43610 rate is calculated
Each of 43610’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 · 43610
RVUs × geographic indexes × conversion factor
Work15.93
15.93 RVUs× 1.000 GPCI
Practice expense7.54
7.54 RVUs× 1.000 GPCI
Malpractice4.07
4.07 RVUs× 1.000 GPCI
Adjusted RVUs
27.5400
Conversion factor
$33.4009
Medicare rate
$919.86
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43610
43610 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43610
Gastric lesion excision
| 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 · 43610
Gastric lesion excision
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
43610 without 51 · national facility
$919.86
Gastric lesion excision
43610-51 · Second procedure: 50%
$459.93
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%).
43610 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43605Stomach biopsy
- 43605 is for biopsy by laparotomy, when tissue is sampled. 43610 is for operative removal of the localized lesion.
- 43611Stomach lesion excision
- Choose 43611 when excision of the local lesion includes partial gastrectomy; 43610 describes local excision without that resection.
- 43631Partial gastrectomy
- 43631 describes distal partial gastrectomy with gastroduodenostomy. It represents a defined gastric resection and reconstruction, not local lesion excision.
- 43659Unlisted laps px stomach
- 43659 is an unlisted code for laparoscopic stomach procedures without a specific code. 43610 describes open local lesion excision.
43610 billing questions
How is 43610 different from 43605?
43610 represents removal of a localized gastric lesion. Use 43605 when the surgeon obtains a stomach biopsy by laparotomy for tissue sampling rather than excising the lesion.
When should 43611 be considered instead?
Use 43611 when the local lesion excision includes a partial gastrectomy. The operative report should make clear whether the surgeon performed that gastric resection.
Can modifier 50 be reported?
No. The stomach procedure is not reported bilaterally, so modifier 50 is inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens if another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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