Billing code 47721: Combined bypassMedicare rate & RVUs in Texas
A combined bypass connecting the gallbladder and stomach to intestine, reported when both anastomoses are created during the same operation.
CMS doesn’t publish an office rate for 47721 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 47721 covers
This operation creates two intestinal connections: one from the gallbladder to the bowel to divert bile, and another from the stomach to the bowel to bypass an obstruction. It may be used in abdominal surgery when both biliary drainage and passage of stomach contents need surgical bypass, such as in selected patients with advanced pancreatic or periampullary disease. The surgeon’s operative report should establish that both connections were performed and identify the anatomy used.
Report the combined service when the operation includes both the gallbladder-to-bowel and stomach-to-bowel anastomoses. The major-surgery global period 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 the others at 50%. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery 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 47721 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 | $1,276.90 |
| Beaumont | Unavailable | $1,229.17 |
| Brazoria | Unavailable | $1,236.22 |
| Dallas | Unavailable | $1,253.71 |
| Fort Worth | Unavailable | $1,252.51 |
| Galveston | Unavailable | $1,246.15 |
| Houston | Unavailable | $1,351.03 |
| Rest Of Texas | Unavailable | $1,238.56 |
How the 47721 rate is calculated
Each of 47721’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 · 47721
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.44Practice expense 11.03Malpractice 5.73
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 47721
47721 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 47721
Combined bypass
| 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 · 47721
Combined bypass
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
47721 without 51 · national facility
$1,275.91
Combined bypass
47721-51 · Second procedure: 50%
$637.96
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%).
47721 compared with similar codes
Compare codes
47721 vs 47720 vs 47740 vs 47760: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 47720Biliary bypass
- 47720 describes a gallbladder-to-bowel bypass without the combined stomach-to-bowel connection. Choose 47721 when both anastomoses are performed.
- 47740Biliary bypass
- 47740 is another gallbladder-to-bowel bypass code. Select based on the specific operation documented, not simply because the patient has biliary obstruction.
- 47760Biliary bypass
- 47760 connects the bile duct to bowel; this code includes a gallbladder-to-bowel connection together with a stomach-to-bowel bypass.
47721 billing questions
When is this code preferable to 47720?
Use this code when the operation includes both a gallbladder-to-bowel connection and a stomach-to-bowel connection. Code 47720 represents a gallbladder-to-bowel bypass without that combined gastric bypass service.
Can the gastroenterostomy be reported separately?
This code represents the combined operation, including both connections. The operative report should document each anastomosis rather than describing only a biliary bypass.
Should modifier 50 be appended?
No. The anatomy and service represented by this code make bilateral reporting with modifier 50 inappropriate.
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 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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