No office rate
43605 is for biopsy by laparotomy, when tissue is sampled. 43610 is for operative removal of the localized lesion.
On this page
CMS RVU26D · Effective 2026-10-01
43610 Gastric lesion excision Medicare reimbursement rates in Rhode Island
Report 43610 when a surgeon operatively removes a focal gastric lesion without performing the partial gastrectomy represented by a more extensive resection code. Compare 43610 office and facility rates across CMS payment localities in Rhode Island.
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 43610 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$923.60
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Gastric surgery
About 43610: Open excision of localized gastric lesion
Report 43610 when a surgeon operatively removes a focal gastric lesion without performing the partial gastrectomy represented by a more extensive resection code.
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.
CMS billing rules for 43610
- 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 RVU15.93 · 58%
- Practice expense (office) RVU7.54 · 27%
- Malpractice RVU4.07 · 15%
459
Medicare services in 2024 · #3635 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.
43610 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
Choose 43611 when excision of the local lesion includes partial gastrectomy; 43610 describes local excision without that resection.
No office rate
43631 describes distal partial gastrectomy with gastroduodenostomy. It represents a defined gastric resection and reconstruction, not local lesion excision.
43659
No office rateUnlisted laps px stomach
43659 is an unlisted code for laparoscopic stomach procedures without a specific code. 43610 describes open local lesion excision.
Compare 43610 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$923.60
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43610 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,263
- Code
- 43610
- Physician work
- 15.93
- Practice expense
- 7.54
- Malpractice
- 4.07
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.93 | × 1.019 | 16.2327 |
| Practice expense | 7.54 | × 1.033 | 7.7888 |
| Malpractice | 4.07 | × 0.892 | 3.6304 |
| Total RVUs | 27.6519 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$923.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.93 | 1.019 |
| Practice expense | 7.54 | 1.033 |
| Malpractice | 4.07 | 0.892 |
(15.93 × 1.019 + 7.54 × 1.033 + 4.07 × 0.892) × $33.4009 = $923.60
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
5,26043510,,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
5,26143520,,Incision of pyloric muscle,A,,11.01,6.44,NA,6.44,,2.94,20.39,20.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,26243605,,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537