No office rate
Choose 43800 for surgical widening of the pylorus. Choose 43810 when the surgeon creates a direct connection between the stomach and duodenum.
On this page
CMS RVU26D · Effective 2026-10-01
43800 Pyloroplasty Medicare reimbursement rates in Washington
Reports surgical enlargement of the pyloric outlet, commonly to improve gastric emptying when narrowing obstructs passage from the stomach. Compare 43800 office and facility rates across CMS payment localities in Washington.
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 43800 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$860.69–$928.70
2 of 2 localities have a supported rate.
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.
Gastric surgery
About 43800: Pyloric outlet widening surgery
Reports surgical enlargement of the pyloric outlet, commonly to improve gastric emptying when narrowing obstructs passage from the stomach.
A surgeon enlarges the pyloric channel, the outlet between the stomach and duodenum, by surgically opening and reconstructing the area to improve passage of stomach contents. The procedure may be performed for gastric outlet narrowing, including narrowing associated with peptic ulcer disease, or as a drainage procedure during gastric surgery. It is typically performed in an operating room by a general or gastrointestinal surgeon.
Report 43800 when the operative work is pyloroplasty, rather than creation of a bypass or a stomach-to-duodenum connection. The operative report should identify the pylorus as the site and describe the incision and reconstruction that widen the outlet. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43800
- 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 RVU15.04 · 58%
- Practice expense (office) RVU7.30 · 28%
- Malpractice RVU3.74 · 14%
209
Medicare services in 2024 · #4286 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.
43800 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
43800 enlarges the existing gastric outlet. 43820 creates a gastrojejunostomy, routing stomach contents to the jejunum.
No office rate
43825 describes a gastrojejunostomy performed with vagotomy. It is not the code for widening the pyloric outlet.
Compare 43800 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$860.69
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$928.70
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43800 billing questions
How does pyloroplasty differ from gastroduodenostomy?
Pyloroplasty widens the existing pyloric outlet. Gastroduodenostomy creates a connection between the stomach and duodenum.
Is related postoperative care separately reported during the global period?
The 90-day global period includes related postoperative care and the day-before preoperative visit. Report a separate service only when the circumstances support separate reporting under applicable coding rules.
How is 43800 affected when another procedure is performed in the same session?
CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and other procedures are paid at 50%.
What documentation supports reporting pyloroplasty?
The operative report should identify work on the pylorus and describe how the outlet was surgically widened. Documentation of a bypass or a different reconstruction supports consideration of the code for that procedure instead.
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 for this code.
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.
5,29543773,,Lap replace gastr adj device,A,,20.27,10.42,NA,10.42,,5.42,36.11,36.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29643774,,Lap rmvl gastr adj all parts,A,,15.37,7.73,NA,7.73,,4.07,27.17,27.17,0,090,0.09,0.84,0.07,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29743775,,Lap sleeve gastrectomy,A,,19.87,4.81,NA,4.81,,5.26,29.94,29.94,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29843800,,Pyloroplasty,A,,15.04,7.30,NA,7.30,,3.74,26.08,26.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,29943810,,Gastroduodenostomy,A,,16.46,7.76,NA,7.76,,4.40,28.62,28.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30043820,,Gastrojejunostomy wo vagotmy,A,,21.97,10.11,NA,10.11,,5.54,37.62,37.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30143825,,Gastrojejunostomy w/vagotomy,A,,21.22,9.94,NA,9.94,,5.68,36.84,36.84,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00