Billing code 43500: GastrotomyMedicare rate & RVUs in Utah
Report this service when a surgeon opens the stomach during an operation to inspect it or obtain one or more gastric biopsies.
CMS doesn’t publish an office rate for 43500 in Utah.
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 43500 covers
A surgeon makes an operative opening in the stomach to examine its interior or take biopsy tissue. General surgeons typically perform this procedure in a hospital operating room as part of abdominal surgery when direct access to the stomach is needed; it is not an endoscopic biopsy. The code covers exploration or one or more biopsies through the gastrotomy.
Choose the code when the operative record documents the gastric incision and its exploratory or biopsy purpose. The 90-day 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 other procedures are subject to the standard multiple-procedure 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 procedure.
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.
43500 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $727.17 |
How the 43500 rate is calculated
Each of 43500’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 · 43500
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.47Practice expense 6.79Malpractice 3.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 43500
43500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43500
Gastrotomy
| 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 · 43500
Gastrotomy
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
43500 without 51 · national facility
$751.85
Gastrotomy
43500-51 · Second procedure: 50%
$375.93
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%).
43500 compared with similar codes
Compare codes
43500 vs 43501 vs 43502 vs 43510 vs 43520: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 43501Gastric repair
- Use 43500 for gastric exploration or biopsy through an operative opening. Choose 43501 when the documented procedure is gastric repair.
- 43502Gastric repair
- 43500 describes opening the stomach for inspection or biopsy; 43502 is a gastric repair service.
- 43510Gastrotomy
- Both involve an operative gastric opening, but 43500 is selected for exploration or biopsy; use 43510 when its distinct procedure is performed.
- 43520Pyloromyotomy
- 43520 involves incision of the pyloric muscle, rather than opening the stomach for exploration or biopsy.
43500 billing questions
When should 43500 be reported instead of a gastric repair code?
Report 43500 when the stomach is opened for exploration or biopsy. A procedure whose purpose is to repair a gastric defect or lesion belongs to the applicable repair code instead.
Does 43500 cover multiple gastric biopsies?
Yes. The service includes one or more biopsies taken through the gastrotomy; do not report additional units of 43500 just for additional biopsy samples.
Can modifier 50 be used for a gastrotomy?
No. Modifier 50 is inappropriate for this procedure.
How does the 90-day global period affect billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session handled?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and 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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