No office rate
43870 addresses closure of a gastrostomy opening. CPT 43880 is for a fistula connecting the stomach and colon.
On this page
CMS RVU26D · Effective 2026-10-01
43880 Fistula closure Medicare reimbursement rates in Vermont
Reports operative closure of an abnormal connection between the stomach and colon, with payment subject to the major-surgery global period and applicable same-session reductions. Compare 43880 office and facility rates across CMS payment localities in Vermont.
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 43880 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1375.96
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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.
Gastrointestinal surgery
About 43880: Gastrocolic fistula closure
Reports operative closure of an abnormal connection between the stomach and colon, with payment subject to the major-surgery global period and applicable same-session reductions.
CPT 43880 describes surgery to close a gastrocolic fistula, an abnormal passage connecting the stomach and colon. A general or gastrointestinal surgeon typically performs the repair in an operating room. The operative record should identify the connection and document the work done to close it; a gastrostomy opening or a different gastric anastomosis is not this fistula.
Report the code for the fistula closure, supported by the operative findings and procedure details. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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 50% reduction. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this service.
CMS billing rules for 43880
- 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 RVU26.50 · 59%
- Practice expense (office) RVU11.22 · 25%
- Malpractice RVU7.09 · 16%
109
Medicare services in 2024 · #4816 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.
43880 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
43810 describes a gastroduodenal anastomosis, connecting the stomach and duodenum; it is not closure of a gastrocolic fistula.
No office rate
43820 describes a gastrojejunal anastomosis without vagotomy. Choose 43880 when the documented procedure closes a stomach-to-colon fistula.
Compare 43880 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
Unavailable
Facility
$1375.96
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 43880 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,315
- Code
- 43880
- Physician work
- 26.50
- Practice expense
- 11.22
- Malpractice
- 7.09
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.50 | × 1.000 | 26.5000 |
| Practice expense | 11.22 | × 0.990 | 11.1078 |
| Malpractice | 7.09 | × 0.506 | 3.5875 |
| Total RVUs | 41.1953 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$1375.96
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.5 | 1 |
| Practice expense | 11.22 | 0.99 |
| Malpractice | 7.09 | 0.506 |
(26.5 × 1 + 11.22 × 0.99 + 7.09 × 0.506) × $33.4009 = $1375.96
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
43880 billing questions
How is this different from surgical gastrostomy closure, 43870?
43880 closes a connection between the stomach and colon. Use 43870 for surgical closure of a gastrostomy opening.
What documentation supports 43880?
The operative report should identify the gastrocolic fistula and describe the surgical closure performed. Document other distinct procedures separately.
Is the day-before visit included in the global period?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How is 43880 paid when other 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.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be appended?
No. The anatomy and service do not support bilateral reporting, so modifier 50 is inappropriate.
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.
5,31243860,,Revj gstr/jj anast w/o vgtmy,A,,27.19,11.29,NA,11.29,,6.91,45.39,45.39,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31343865,,Revj gstr/jj anast w/vgtmy,A,,28.32,11.66,NA,11.66,,7.57,47.55,47.55,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31443870,,Closure gastrostomy surgical,A,,11.15,6.30,NA,6.30,,2.72,20.17,20.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31543880,,Closure gastrocolic fistula,A,,26.50,11.22,NA,11.22,,7.09,44.81,44.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31643881,,Impl/rplcmt gstr nstim eltrd,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31743882,,Rev/rmvl gstr nstim eltrd,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31843886,,Gstr rstcv px opn revj port,A,,4.52,5.43,NA,5.43,,1.21,11.16,11.16,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817