Billing code 43860: Anastomosis revisionMedicare rate & RVUs in Virginia
Reports operative revision of an existing connection between the stomach and jejunum when the service does not include vagotomy.
CMS doesn’t publish an office rate for 43860 in Virginia.
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 43860 covers
A surgeon revises an existing gastrojejunal connection, the surgically created passage between the stomach and jejunum. The operation may address a problem at that connection and can involve reconstruction or work on adjacent stomach, as supported by the operative report. It is performed in an operating room, commonly by a general or gastrointestinal surgeon; Medicare recorded facility services for this code in 2024.
Report this code when the surgeon revises the existing anastomosis without performing vagotomy, rather than creating a new gastrojejunostomy or revising a gastric restrictive procedure. Documentation should identify the prior connection, the reason and operative work for its revision, and whether vagotomy was performed. The service has 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 is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 43860 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $1,658.31 |
| Virginia | Unavailable | $1,441.80 |
How the 43860 rate is calculated
Each of 43860’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 · 43860
RVUs × geographic indexes × conversion factor
Work27.19
27.19 RVUs× 1.000 GPCI
Practice expense11.29
11.29 RVUs× 1.000 GPCI
Malpractice6.91
6.91 RVUs× 1.000 GPCI
Adjusted RVUs
45.3900
Conversion factor
$33.4009
Medicare rate
$1,516.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 43860
43860 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 43860
Anastomosis revision
| 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 · 43860
Anastomosis revision
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
43860 without 51 · national facility
$1,516.07
Anastomosis revision
43860-51 · Second procedure: 50%
$758.04
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%).
43860 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 43820Gastrojejunostomy
- Code 43820 is for creating a gastrojejunostomy without vagotomy. Use 43860 when revising an existing gastrojejunal connection without vagotomy.
- 43865Anastomosis revision
- Both codes address revision of a gastrojejunal connection; 43865 applies when vagotomy is performed, while 43860 is for revision without vagotomy.
- 43848Bariatric revision
- Code 43848 addresses revision of a prior gastric restrictive operation. Code 43860 is specific to revision of a gastrojejunal anastomosis.
43860 billing questions
How is this different from code 43820?
Use 43860 for revision of an existing gastrojejunal connection without vagotomy. Code 43820 describes creating a gastrojejunostomy without vagotomy.
When does code 43865 apply instead?
Code 43865 is the revision counterpart when the operation includes vagotomy. The operative report should establish whether vagotomy was performed.
Can modifier 50 be used?
No. The procedure involves a single gastrointestinal anastomosis, not paired right- and left-side anatomy.
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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