Billing code 43845: Duodenal switchMedicare rate & RVUs in Texas
Reports bariatric surgery combining partial stomach removal with preserved pyloric passage and intestinal rerouting through duodenoileal and ileoileal connections.
CMS doesn’t publish an office rate for 43845 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 43845 covers
This operation combines removal of part of the stomach with intestinal rerouting while preserving the pylorus. The surgeon connects the duodenum to the ileum and creates a second intestinal connection, changing how food and digestive secretions travel through the bowel. It is performed by a bariatric or gastrointestinal surgeon, typically in a hospital operating room, as a weight-loss procedure for a patient with severe obesity.
Choose this code when the operative report supports the pylorus-preserving duodenal-switch anatomy, including the partial gastrectomy and both intestinal connections; the label “bariatric surgery” alone is not enough. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this single reconstructive operation. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
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 43845 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 | $1,823.03 |
| Beaumont | Unavailable | $1,765.64 |
| Brazoria | Unavailable | $1,768.63 |
| Dallas | Unavailable | $1,794.32 |
| Fort Worth | Unavailable | $1,793.48 |
| Galveston | Unavailable | $1,783.28 |
| Houston | Unavailable | $1,940.14 |
| Rest Of Texas | Unavailable | $1,775.99 |
How the 43845 rate is calculated
Each of 43845’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 · 43845
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 32.47Practice expense 13.66Malpractice 8.57
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43845
43845 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43845
Duodenal switch
| 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 · 43845
Duodenal switch
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
43845 without 51 · national facility
$1,827.03
Duodenal switch
43845-51 · Second procedure: 50%
$913.52
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%).
43845 compared with similar codes
Compare codes
43845 vs 43846 vs 43847 vs 43843: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43846Gastric bypass
- Use 43845 for the pylorus-preserving duodenal switch with duodenoileal and ileoileal connections. Use 43846 for the short-limb Roux-en-Y gastric bypass configuration.
- 43847Bariatric surgery
- Code 43847 describes gastric restriction with intestinal reconstruction to limit absorption, but not the specific pylorus-preserving duodenal-switch anatomy reported with 43845.
- 43843Gastric restriction
- Code 43843 represents another restrictive gastric procedure, rather than the partial gastrectomy and two intestinal connections that define the duodenal switch.
43845 billing questions
How is this different from code 43846?
This code describes a pylorus-preserving duodenal switch with duodenoileal and ileoileal connections. Code 43846 describes a gastric bypass using a short-limb Roux-en-Y reconstruction.
What operative details support reporting this code?
The operative report should establish partial gastrectomy with preservation of the pylorus and the duodenoileal and ileoileal connections. A general reference to bariatric surgery does not establish this specific reconstruction.
Is modifier 50 appropriate?
No. The procedure is a single reconstructive operation, not a bilateral service.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
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 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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