43800
No office ratePyloroplasty
Pyloroplasty enlarges the pyloric outlet; this code is for suture repair of a perforated gastric or duodenal ulcer, wound, or injury.
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CMS RVU26D · Effective 2026-10-01
43840 Ulcer repair Medicare reimbursement rates in Texas
Reports operative suture repair of a perforated gastric or duodenal ulcer, wound, or injury when the surgeon closes the defect directly. Compare 43840 office and facility rates across CMS payment localities in Texas.
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 43840 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
No 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.
Where 43840 pays more and less in Texas
Gastrointestinal surgery
About 43840: Suture repair of gastric or duodenal perforation
Reports operative suture repair of a perforated gastric or duodenal ulcer, wound, or injury when the surgeon closes the defect directly.
A surgeon uses this service to close a perforation in the stomach or duodenum caused by an ulcer, wound, or injury. It is typically performed by a general or acute care surgeon in a hospital operating room, often for an urgent abdominal presentation. The operative report should identify the affected organ, the cause and location of the defect, and the suture repair performed. This code describes direct repair, not a bypass or anastomosis created to reconstruct the upper gastrointestinal tract.
Report the code when the operative work is suture closure of the qualifying defect. CMS assigns 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 procedure is paid in full and others at 50%. Bilateral adjustment is not made; modifier 50 is inappropriate. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43840
- 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 RVU22.26 · 58%
- Practice expense (office) RVU10.11 · 27%
- Malpractice RVU5.73 · 15%
4.5K
Medicare services in 2024 · #1943 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.
43840 compared with similar codes
Office rates for Texas, from the same CMS release.
No office rate
Gastroduodenostomy creates a connection between the stomach and duodenum. Use this code for direct suture closure of a qualifying perforation.
No office rate
Gastrojejunostomy creates a connection between the stomach and jejunum. It is not the code for direct suture repair of a perforation.
No office rate
This code revises a gastrojejunal anastomosis without vagotomy; it does not describe primary suture closure of a gastric or duodenal perforation.
Compare 43840 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office Unavailable | Facility $1271.83 |
| Beaumont | Office Unavailable | Facility $1228.59 |
| Brazoria | Office Unavailable | Facility $1233.38 |
| Dallas | Office Unavailable | Facility $1250.74 |
| Fort Worth | Office Unavailable | Facility $1249.85 |
| Galveston | Office Unavailable | Facility $1243.24 |
| Houston | Office Unavailable | Facility $1348.12 |
| Rest Of Texas | Office Unavailable | Facility $1236.79 |
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43840 billing questions
When should I report this instead of a gastrojejunostomy?
Report this code for direct suture closure of a gastric or duodenal perforation. A gastrojejunostomy describes creation of a connection between the stomach and jejunum, not direct closure.
What operative documentation supports this code?
The report should identify the stomach or duodenum, describe the ulcer, wound, or injury and its perforation, and document the suture repair.
Does the code have a postoperative global period?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used?
No. CMS does not apply a bilateral adjustment to this code, and modifier 50 is inappropriate.
How are other same-session procedures paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
Can this be billed as team surgery?
No. CMS does not permit team surgery for this code.
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.
5,30243830,,Gstrst open wo constj tube,A,,10.58,6.98,NA,6.98,,2.68,20.24,20.24,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30343831,,Gastrostomy open neonatal,A,,8.28,7.45,NA,7.45,,2.20,17.93,17.93,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30443832,,Gstrst open w/constj tube,A,,16.91,8.23,NA,8.23,,4.38,29.52,29.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30543840,,Gstrrphy sutr duol/gstr ulcr,A,,22.26,10.11,NA,10.11,,5.73,38.10,38.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30643842,,Gstr rstcv px v-banded gstp,N,+,20.50,7.80,NA,7.80,,2.19,30.49,30.49,9,090,0.09,0.81,0.10,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30743843,,Gstr rstcv oth/thn v-band,A,,20.68,9.91,NA,9.91,,5.53,36.12,36.12,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30843845,,Gastroplasty duodenal switch,A,,32.47,13.66,NA,13.66,,8.57,54.70,54.70,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00