No office rate
Choose 43641 when the vagotomy includes a pyloric drainage repair. Choose 43640 for a vagotomy without drainage.
On this page
CMS RVU26D · Effective 2026-10-01
43641 Vagotomy Medicare reimbursement rates in Tennessee
Reports an open vagotomy combined with a pyloric drainage repair, typically performed to reduce acid secretion while facilitating passage of stomach contents. Compare 43641 office and facility rates across CMS payment localities in Tennessee.
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 43641 in Tennessee?
Tennessee 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
$1025.17
1 of 1 localities have a supported rate.
Payment area: Tennessee
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 43641: Vagotomy with pyloric drainage
Reports an open vagotomy combined with a pyloric drainage repair, typically performed to reduce acid secretion while facilitating passage of stomach contents.
This operation divides vagal nerve input to the stomach and includes a repair that widens or improves drainage through the pylorus. It is a nonlaparoscopic abdominal procedure performed by a surgeon, typically in a hospital operating room. A familiar clinical context is surgical treatment of peptic ulcer disease when acid-reducing surgery and improved gastric emptying are both part of the operative plan.
Select this code when the operative report supports both the vagotomy and the pyloric drainage procedure; a vagotomy without drainage is a different service. Documentation should identify the nerve procedure and describe the pyloric repair. The pyloric work is included in this combined service. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this code.
CMS billing rules for 43641
- 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 RVU19.31 · 57%
- Practice expense (office) RVU9.48 · 28%
- Malpractice RVU5.15 · 15%
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.
43641 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
43651 describes laparoscopic vagotomy without drainage. It differs from 43641 in both approach and the absence of a pyloric drainage procedure.
No office rate
43652 describes laparoscopic vagotomy with drainage. Use 43641 for the nonlaparoscopic operation with pyloric drainage.
Compare 43641 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
Tennessee →
Office / nonfacility
Unavailable
Facility
$1025.17
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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 43641 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,274
- Code
- 43641
- Physician work
- 19.31
- Practice expense
- 9.48
- Malpractice
- 5.15
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.31 | × 1.000 | 19.3100 |
| Practice expense | 9.48 | × 0.909 | 8.6173 |
| Malpractice | 5.15 | × 0.537 | 2.7656 |
| Total RVUs | 30.6929 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$1025.17
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.31 | 1 |
| Practice expense | 9.48 | 0.909 |
| Malpractice | 5.15 | 0.537 |
(19.31 × 1 + 9.48 × 0.909 + 5.15 × 0.537) × $33.4009 = $1025.17
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.
43641 billing questions
How does this differ from 43640?
43641 includes a pyloric drainage repair with the vagotomy. Use 43640 when the documented vagotomy is performed without a drainage procedure.
Is the pyloric repair separately reported?
The pyloric drainage work is part of 43641. Do not report that same included work again as a separate service.
Should modifier 50 be appended?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this procedure.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery 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 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.
5,27143634,,Removal of stomach partial,A,,35.72,13.45,NA,13.45,,9.57,58.74,58.74,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27243635,,Removal of stomach partial,A,,2.01,0.48,NA,0.48,,0.53,3.02,3.02,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27343640,,Vagotomy & pylorus repair,A,,19.07,9.42,NA,9.42,,5.09,33.58,33.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27443641,,Vagotomy & pylorus repair,A,,19.31,9.48,NA,9.48,,5.15,33.94,33.94,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27543644,,Lap gastric bypass/roux-en-y,A,,28.67,12.14,NA,12.14,,7.64,48.45,48.45,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27643645,,Lap gastr bypass incl smll i,A,,30.74,12.59,NA,12.59,,8.11,51.44,51.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,27743647,,Lap impl electrode antrum,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
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
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780