Billing code 43621: Total gastrectomyMedicare rate & RVUs in Oregon
Report this service for complete stomach removal followed by Roux-en-Y reconstruction, commonly performed for gastric malignancy or other disease requiring total gastrectomy.
CMS doesn’t publish an office rate for 43621 in Oregon.
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 43621 covers
The operation removes the stomach in its entirety and restores continuity by connecting the esophagus to a Roux-en-Y limb of small intestine. General surgeons and surgical oncologists perform it in an operating room, commonly for gastric cancer or other disease requiring complete removal. The documented reconstruction distinguishes this service from total gastrectomy without that configuration or with an intestinal pouch.
Report the code when the operative record supports both complete stomach removal and Roux-en-Y reconstruction; a partial resection or lesion excision is not enough. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. Modifier 50 is inappropriate for this single-organ procedure. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
Where 43621 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $2,081.55 |
| Rest Of Oregon | Unavailable | $1,992.64 |
How the 43621 rate is calculated
Each of 43621’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 · 43621
RVUs × geographic indexes × conversion factor
Work38.54
38.54 RVUs× 1.000 GPCI
Practice expense14.30
14.30 RVUs× 1.000 GPCI
Malpractice9.78
9.78 RVUs× 1.000 GPCI
Adjusted RVUs
62.6200
Conversion factor
$33.4009
Medicare rate
$2,091.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43621
43621 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43621
Total gastrectomy
| 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 · 43621
Total gastrectomy
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
43621 without 51 · national facility
$2,091.56
Total gastrectomy
43621-51 · Second procedure: 50%
$1,045.78
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%).
43621 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 43620Total gastrectomy
- Both describe total stomach removal; 43621 includes Roux-en-Y reconstruction, while 43620 is for total gastrectomy without that reconstruction.
- 43622Total gastrectomy
- This code is for total gastrectomy with Roux-en-Y reconstruction. Choose 43622 when the operation forms an intestinal pouch instead.
- 43631Partial gastrectomy
- 43631 represents partial stomach removal with gastroduodenostomy. Use 43621 only when the entire stomach is removed and the documented reconstruction is Roux-en-Y.
- 43610Gastric lesion excision
- 43610 is for excision of a stomach lesion, not complete stomach removal. The operative extent determines which service was performed.
43621 billing questions
How is this distinguished from 43620?
Use 43621 when the total gastrectomy includes Roux-en-Y reconstruction. Code 43620 describes total gastrectomy without that reconstruction.
When is 43622 a better fit?
Use 43622 when the total gastrectomy includes formation of an intestinal pouch. The reconstruction documented in the operative report determines the choice.
Can a partial gastrectomy be reported with this code?
No. This code represents removal of the entire stomach; a resection that leaves part of the stomach is represented by an appropriate partial-gastrectomy code.
Should modifier 50 be used?
No. The code represents removal of a single stomach, 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.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
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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