$252.03–$283.58
43762 describes percutaneous tube replacement without imaging or endoscopic guidance. Choose 43870 when the service surgically closes the gastrostomy rather than maintaining access.
On this page
CMS RVU26D · Effective 2026-10-01
43870 Gastrostomy closure Medicare reimbursement rates in Pennsylvania
Reports surgical closure of a gastrostomy opening and tract, commonly when a feeding tube is no longer needed and the site remains patent. Compare 43870 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 43870 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
$651.44–$706.56
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 43870: Surgical gastrostomy tract closure
Reports surgical closure of a gastrostomy opening and tract, commonly when a feeding tube is no longer needed and the site remains patent.
A surgeon closes the gastric opening and gastrostomy tract when enteral access is no longer needed and the site does not seal after tube removal. The service is typically performed in an operating room, including for a persistent gastrocutaneous opening after a feeding gastrostomy has been discontinued. This is definitive surgical closure, not routine removal or exchange of a tube.
Report the procedure when the operative record supports surgical closure of the gastrostomy, rather than continued access or tube maintenance. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. 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 multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 43870
- 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 RVU11.15 · 55%
- Practice expense (office) RVU6.30 · 31%
- Malpractice RVU2.72 · 13%
659
Medicare services in 2024 · #3317 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.
43870 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
43830 creates an open gastrostomy without construction of a gastric tube; 43870 closes an existing gastrostomy.
No office rate
43832 creates an open gastrostomy with construction of a gastric tube. It establishes access, unlike 43870, which closes the opening.
No office rate
43880 closes a gastrocolic fistula. Use 43870 for surgical closure of a gastrostomy, not a fistula between the stomach and colon.
Compare 43870 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
$706.56
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$651.44
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43870 billing questions
When is this code appropriate instead of a gastrostomy tube replacement code?
Use 43870 for definitive surgical closure of the gastrostomy opening and tract. Tube replacement codes apply when enteral access is being maintained and the tube is exchanged.
Does this code include routine tube removal?
No. The service is surgical closure of the gastrostomy, not simply taking out a tube; the operative documentation should support closure of the opening and tract.
How does the global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. Unrelated services are not described by this global-period rule.
Can modifier 50 be used for closure of two gastrostomies?
No. CMS identifies bilateral adjustment as inappropriate for this code. Modifier 50 should not be used.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, while other procedures in the session are subject to the standard multiple-procedure reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
What documentation supports co-surgeon billing?
CMS requires supporting documentation for co-surgeons. The record should substantiate the co-surgeons' participation in the surgical service.
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.
5,31143848,,Revj open gstr rstcv px,A,,31.93,13.40,NA,13.40,,8.32,53.65,53.65,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31243860,,Revj gstr/jj anast w/o vgtmy,A,,27.19,11.29,NA,11.29,,6.91,45.39,45.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31343865,,Revj gstr/jj anast w/vgtmy,A,,28.32,11.66,NA,11.66,,7.57,47.55,47.55,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31443870,,Closure gastrostomy surgical,A,,11.15,6.30,NA,6.30,,2.72,20.17,20.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31543880,,Closure gastrocolic fistula,A,,26.50,11.22,NA,11.22,,7.09,44.81,44.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31643881,,Impl/rplcmt gstr nstim eltrd,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31743882,,Rev/rmvl gstr nstim eltrd,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00