No office rate
Code 43820 is for creating a gastrojejunostomy without vagotomy. Use 43860 when revising an existing gastrojejunal connection without vagotomy.
On this page
CMS RVU26D · Effective 2026-10-01
43860 Anastomosis revision Medicare reimbursement rates in Tennessee
Reports operative revision of an existing connection between the stomach and jejunum when the service does not include vagotomy. Compare 43860 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 43860 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
$1374.89
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 43860: Gastrojejunal anastomosis revision without vagotomy
Reports operative revision of an existing connection between the stomach and jejunum when the service does not include vagotomy.
A surgeon revises an existing gastrojejunal connection, the surgically created passage between the stomach and jejunum. The operation may address a problem at that connection and can involve reconstruction or work on adjacent stomach, as supported by the operative report. It is performed in an operating room, commonly by a general or gastrointestinal surgeon; Medicare recorded facility services for this code in 2024.
Report this code when the surgeon revises the existing anastomosis without performing vagotomy, rather than creating a new gastrojejunostomy or revising a gastric restrictive procedure. Documentation should identify the prior connection, the reason and operative work for its revision, and whether vagotomy was performed. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued is paid in full and others at 50%. Modifier 50 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 43860
- 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 RVU27.19 · 60%
- Practice expense (office) RVU11.29 · 25%
- Malpractice RVU6.91 · 15%
408
Medicare services in 2024 · #3724 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.
43860 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
Both codes address revision of a gastrojejunal connection; 43865 applies when vagotomy is performed, while 43860 is for revision without vagotomy.
No office rate
Code 43848 addresses revision of a prior gastric restrictive operation. Code 43860 is specific to revision of a gastrojejunal anastomosis.
Compare 43860 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
$1374.89
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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 43860 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,312
- Code
- 43860
- Physician work
- 27.19
- Practice expense
- 11.29
- Malpractice
- 6.91
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 27.19 | × 1.000 | 27.1900 |
| Practice expense | 11.29 | × 0.909 | 10.2626 |
| Malpractice | 6.91 | × 0.537 | 3.7107 |
| Total RVUs | 41.1633 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$1374.89
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 27.19 | 1 |
| Practice expense | 11.29 | 0.909 |
| Malpractice | 6.91 | 0.537 |
(27.19 × 1 + 11.29 × 0.909 + 6.91 × 0.537) × $33.4009 = $1374.89
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.
43860 billing questions
How is this different from code 43820?
Use 43860 for revision of an existing gastrojejunal connection without vagotomy. Code 43820 describes creating a gastrojejunostomy without vagotomy.
When does code 43865 apply instead?
Code 43865 is the revision counterpart when the operation includes vagotomy. The operative report should establish whether vagotomy was performed.
Can modifier 50 be used?
No. The procedure involves a single gastrointestinal anastomosis, not paired right- and left-side anatomy.
What postoperative care is included?
The 90-day global period 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 made. 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.
5,30943846,,Gstr rstcv px shrt roux-en-y,A,,26.72,12.45,NA,12.45,,7.16,46.33,46.33,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31043847,,Gstr rstcv px sm int rcnstj,A,,29.52,13.12,NA,13.12,,7.90,50.54,50.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31143848,,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
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