No office rate
Both codes describe total gastrectomy, but the reconstruction differs. Use 43620 for esophagoenterostomy and select 43621 when its distinct reconstruction matches the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
43620 Total gastrectomy Medicare reimbursement rates in Pennsylvania
Reports removal of the entire stomach with an esophagus-to-small-bowel connection, typically for extensive gastric disease requiring total resection. Compare 43620 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 43620 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
$1782.88–$1929.22
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 43620: Total gastrectomy with bowel connection
Reports removal of the entire stomach with an esophagus-to-small-bowel connection, typically for extensive gastric disease requiring total resection.
This code describes open removal of the entire stomach followed by a connection between the esophagus and small intestine. A general surgeon or surgical oncologist may perform it for gastric cancer or other extensive gastric disease when the operative plan calls for total rather than partial removal. The reconstruction is part of the service, not a separate intestinal procedure.
Select the code when the operative report supports removal of the whole stomach and the specified esophagoenterostomy reconstruction; a partial resection or a different reconstruction points to another code. Documentation should identify the extent of resection and the reconstruction performed. The 90-day global period includes the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43620
- 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 RVU33.19 · 60%
- Practice expense (office) RVU12.84 · 23%
- Malpractice RVU8.89 · 16%
55
Medicare services in 2024 · #5301 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.
43620 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43622 is a separate total gastrectomy variant. Choose between the codes based on the specific reconstruction and operative details required by the full descriptor.
No office rate
43631 describes partial distal stomach removal with reconstruction, not removal of the entire stomach. The extent of resection determines which code applies.
Compare 43620 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
$1929.22
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$1782.88
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43620 billing questions
How is this code distinguished from a partial gastrectomy?
Use 43620 when the entire stomach is removed and the specified esophagoenterostomy reconstruction is performed. Partial removal belongs to a partial gastrectomy code.
How does 43620 differ from other total gastrectomy codes?
The total gastrectomy codes distinguish the reconstruction performed. Match the operative report to the full descriptor, including whether the reconstruction is an esophagoenterostomy or a different configuration.
Is the esophagus-to-small-bowel connection billed separately?
The esophagoenterostomy reconstruction is included in 43620. It is not separately reported as an additional service for the same operative work.
What documentation supports reporting 43620?
The operative report should establish removal of the entire stomach and describe the esophagoenterostomy reconstruction. It should also distinguish the procedure from a partial gastrectomy.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,26243605,,Biopsy of stomach,A,,13.38,7.01,NA,7.01,,3.58,23.97,23.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26343610,,Excision of stomach lesion,A,,15.93,7.54,NA,7.54,,4.07,27.54,27.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26443611,,Excision of stomach lesion,A,,19.87,9.57,NA,9.57,,4.96,34.40,34.40,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26543620,,Removal of stomach,A,,33.19,12.84,NA,12.84,,8.89,54.92,54.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26643621,,Removal of stomach,A,,38.54,14.30,NA,14.30,,9.78,62.62,62.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26743622,,Removal of stomach,A,,39.03,14.26,NA,14.26,,10.46,63.75,63.75,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26843631,,Removal of stomach partial,A,,23.90,10.55,NA,10.55,,6.14,40.59,40.59,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00