43842
No office rateGstr rstcv px v-banded gstp
43842 is specifically for vertical-banded gastroplasty. Code 43843 is for a gastric-restrictive operation other than that technique and without gastric bypass.
On this page
CMS RVU26D · Effective 2026-10-01
43843 Gastric restriction Medicare reimbursement rates in Wisconsin
Reports a gastric-restrictive operation for morbid obesity that limits stomach capacity without gastric bypass and is not vertical-banded gastroplasty. Compare 43843 office and facility rates across CMS payment localities in Wisconsin.
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 43843 in Wisconsin?
Wisconsin 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
$1064.72
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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.
Bariatric surgery
About 43843: Non-VBG gastric restrictive procedure
Reports a gastric-restrictive operation for morbid obesity that limits stomach capacity without gastric bypass and is not vertical-banded gastroplasty.
This code describes an operation for morbid obesity that reduces the stomach’s capacity to restrict food intake, without creating a gastric bypass and without using the vertical-banded gastroplasty technique. A bariatric or general surgeon typically performs the procedure in an operating room. The operative report should identify the procedure actually performed and the changes made to the stomach so the service can be distinguished from bypass, vertical-banded gastroplasty, and revision surgery.
Select this code from the operative technique, not simply from the patient’s obesity diagnosis or the intended weight-loss effect. Documentation should support the indication, anatomy treated, and work performed. 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 multiple-procedure reduction. Assistant-at-surgery and co-surgeon payment may be allowed; team surgery is not permitted under this code’s CMS rules.
CMS billing rules for 43843
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU20.68 · 57%
- Practice expense (office) RVU9.91 · 27%
- Malpractice RVU5.53 · 15%
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.
43843 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
43845 describes a duodenal-switch operation. Use 43843 when the operation is restrictive without a gastric bypass or duodenal-switch reconstruction.
No office rate
43846 includes gastric bypass with a short-limb Roux-en-Y reconstruction. Code 43843 describes restriction without a bypass.
No office rate
43848 is for revision of a prior open gastric-restrictive procedure. Code 43843 describes the restrictive operation itself, rather than revision.
Compare 43843 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$1064.72
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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 43843 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,307
- Code
- 43843
- Physician work
- 20.68
- Practice expense
- 9.91
- Malpractice
- 5.53
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.68 | × 1.000 | 20.6800 |
| Practice expense | 9.91 | × 0.958 | 9.4938 |
| Malpractice | 5.53 | × 0.308 | 1.7032 |
| Total RVUs | 31.8770 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$1064.72
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.68 | 1 |
| Practice expense | 9.91 | 0.958 |
| Malpractice | 5.53 | 0.308 |
(20.68 × 1 + 9.91 × 0.958 + 5.53 × 0.308) × $33.4009 = $1064.72
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.
43843 billing questions
How is this code distinguished from 43842?
43842 describes vertical-banded gastroplasty. Use 43843 for a qualifying gastric-restrictive operation other than that specific technique, without gastric bypass.
Can this code be used for a gastric bypass?
No. The service is a restrictive operation without gastric bypass. Choose a bypass code when the operative procedure includes the bypass reconstruction.
What documentation supports reporting 43843?
The operative report should describe the restrictive technique, the stomach anatomy altered, and the indication for surgery. It should make clear that the procedure was neither vertical-banded gastroplasty nor gastric bypass.
How does the 90-day global period affect postoperative billing?
The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care. Those related services are included in the global surgical package.
Can an assistant or co-surgeon be reported?
CMS indicates that assistant-at-surgery payment may be made and that co-surgeons are permitted. Team surgery is not permitted under this code’s CMS rules.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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.
5,30443832,,Gstrst open w/constj tube,A,,16.91,8.23,NA,8.23,,4.38,29.52,29.52,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30543840,,Gstrrphy sutr duol/gstr ulcr,A,,22.26,10.11,NA,10.11,,5.73,38.10,38.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30643842,,Gstr rstcv px v-banded gstp,N,+,20.50,7.80,NA,7.80,,2.19,30.49,30.49,9,090,0.09,0.81,0.10,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30743843,,Gstr rstcv oth/thn v-band,A,,20.68,9.91,NA,9.91,,5.53,36.12,36.12,0,090,0.09,0.81,0.10,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30843845,,Gastroplasty duodenal switch,A,,32.47,13.66,NA,13.66,,8.57,54.70,54.70,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,30943846,,Gstr rstcv px shrt roux-en-y,A,,26.72,12.45,NA,12.45,,7.16,46.33,46.33,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31043847,,Gstr rstcv px sm int rcnstj,A,,29.52,13.12,NA,13.12,,7.90,50.54,50.54,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,