Billing code 43631: Partial gastrectomyMedicare rate & RVUs in Texas
Open distal partial gastrectomy with reconnection of the remaining stomach to the duodenum, reported when resection and gastroduodenostomy are performed.
CMS doesn’t publish an office rate for 43631 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 43631 covers
This code describes an open operation removing the distal portion of the stomach and reconnecting the gastric remnant directly to the duodenum. General surgeons and surgical oncologists may perform it for a distal gastric tumor or other disease requiring removal of that portion of the stomach. The reconstruction is commonly called a Billroth I. It is distinct from a more limited excision of a stomach lesion and from removal of the entire stomach.
Report the code when the operative note supports distal partial resection and a gastroduodenostomy. Document the portion removed and the reconstruction performed; a different reconstruction may point to another partial-gastrectomy code. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to a 50% 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 stomach operation.
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.
Where 43631 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,354.40 |
| Beaumont | Unavailable | $1,309.47 |
| Brazoria | Unavailable | $1,313.84 |
| Dallas | Unavailable | $1,332.40 |
| Fort Worth | Unavailable | $1,331.54 |
| Galveston | Unavailable | $1,324.39 |
| Houston | Unavailable | $1,436.77 |
| Rest Of Texas | Unavailable | $1,317.88 |
How the 43631 rate is calculated
Each of 43631’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 43631
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.90Practice expense 10.55Malpractice 6.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43631
43631 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43631
Partial gastrectomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 43631
Partial gastrectomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
43631 without 51 · national facility
$1,355.74
Partial gastrectomy
43631-51 · Second procedure: 50%
$677.87
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
43631 compared with similar codes
Compare codes
43631 vs 43632 vs 43633 vs 43620: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43632Partial gastrectomy
- Choose 43632 when the gastric remnant is connected to the jejunum. This code describes direct reconnection to the duodenum.
- 43633Partial gastrectomy
- Choose 43633 for distal partial gastrectomy with Roux-en-Y reconstruction; this code is for gastroduodenostomy.
- 43620Total gastrectomy
- 43620 represents total gastrectomy. This code is for removing only the distal portion of the stomach and reconnecting the remnant to the duodenum.
43631 billing questions
How is this code distinguished from 43632?
This code describes reconnection of the gastric remnant to the duodenum. Code 43632 is for a distal partial gastrectomy reconstructed to the jejunum.
When would 43633 be selected instead?
Use 43633 when the distal partial gastrectomy is reconstructed with a Roux-en-Y configuration rather than a direct connection to the duodenum.
Can a separate lesion excision be reported for the removed stomach?
The gastric resection is integral to this operation. Do not separately report a lesion excision for tissue removed as part of the gastrectomy.
What operative details support reporting this code?
The operative report should establish that the resection was partial and distal, and that the gastric remnant was connected to the duodenum.
How does the 90-day global affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgical payment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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