No office rate
43500 describes gastrotomy for exploration or foreign body removal. Choose 43501 when the service includes suture repair of a perforated ulcer.
On this page
CMS RVU26D · Effective 2026-10-01
43501 Gastric repair Medicare reimbursement rates in Pennsylvania
Reports open stomach access with suture repair of a perforated ulcer, typically during surgery for an acute gastric perforation. Compare 43501 office and facility rates across CMS payment localities in Pennsylvania.
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 43501 in Pennsylvania?
Pennsylvania 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
$1230.17–$1333.24
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.
Gastrointestinal surgery
About 43501: Gastrotomy with perforated ulcer repair
Reports open stomach access with suture repair of a perforated ulcer, typically during surgery for an acute gastric perforation.
This operation involves opening the stomach and suturing a perforated ulcer. A surgeon typically performs it in an operating room when a gastric ulcer has perforated and requires operative repair. The operative report should establish the perforation and document the stomach opening and suture repair; the approach and exact work performed help distinguish this service from other gastric procedures.
Report the code for the ulcer repair, not as a separate charge for the stomach incision used to perform it. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be considered; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this stomach procedure.
CMS billing rules for 43501
- 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 RVU22.04 · 58%
- Practice expense (office) RVU10.11 · 27%
- Malpractice RVU5.83 · 15%
98
Medicare services in 2024 · #4897 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.
43501 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43502 is for gastrotomy with drainage of an abscess or cyst; 43501 is for suture repair of a perforated ulcer.
No office rate
43840 describes gastrorrhaphy for a perforated duodenal or gastric ulcer, wound, or injury. Select based on the operation documented, distinguishing that repair from the gastrotomy service in 43501.
Compare 43501 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$1333.24
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1230.17
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43501 billing questions
When is this code different from 43500?
Use 43501 when the operative service includes suture repair of a perforated ulcer. Code 43500 describes a gastrotomy for exploration or foreign body removal.
Is the stomach incision separately reportable?
The gastrotomy is the access used for the repair described by 43501. Do not report that access incision as a separate service.
Should modifier 50 be appended?
No. A stomach repair is not a bilateral service, so modifier 50 is inappropriate.
How does the 90-day global period affect follow-up?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical episode.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment consideration. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports 43501?
Document the perforated gastric ulcer and the operative stomach opening and suture repair. The operative details should support this service rather than exploration, drainage, or another type of gastric procedure.
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.
5,25443497,,Transorl lwr esophgl myotomy,A,,12.96,6.75,NA,6.75,,1.80,21.51,21.51,0,090,0.09,0.81,0.10,3,0,1,0,0,9,43235,33.4009,09,0,99,0.00,0.00,0.00
5,25543499,,Unlisted procedure esophagus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25643500,,Surgical opening of stomach,A,,12.47,6.79,NA,6.79,,3.25,22.51,22.51,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25743501,,Surgical repair of stomach,A,,22.04,10.11,NA,10.11,,5.83,37.98,37.98,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,25843502,,Surgical repair of stomach,A,,25.05,10.87,NA,10.87,,6.69,42.61,42.61,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,2594350F,,Cnslng provided symp mngmnt,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26043510,,Surgical opening of stomach,A,,14.76,8.37,NA,8.37,,3.93,27.06,27.06,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00