No office rate
Use 43644 for the laparoscopic gastric bypass with Roux-en-Y reconstruction. This code describes the open approach.
On this page
CMS RVU26D · Effective 2026-10-01
43846 Gastric bypass Medicare reimbursement rates in Wyoming
Reports open bariatric gastric bypass creating a small stomach pouch and a short Roux-en-Y connection for treatment of morbid obesity. Compare 43846 office and facility rates across CMS payment localities in Wyoming.
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 43846 in Wyoming?
Wyoming 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
$1485.28
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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 43846: Open short-limb Roux-en-Y gastric bypass
Reports open bariatric gastric bypass creating a small stomach pouch and a short Roux-en-Y connection for treatment of morbid obesity.
The surgeon creates a small stomach pouch and connects it to the small intestine using a Roux-en-Y configuration with a short Roux limb, under 150 cm. This open bariatric operation is performed for morbid obesity, typically by a bariatric or general surgeon in a hospital operating room. The operative report should establish the bypass anatomy and limb length; the short-limb configuration distinguishes this service from longer intestinal reconstruction and other bariatric procedures.
Report the code when the operation performed matches this open short-limb bypass, rather than selecting it solely because the patient underwent bariatric surgery. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 43846
- 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 RVU26.72 · 58%
- Practice expense (office) RVU12.45 · 27%
- Malpractice RVU7.16 · 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.
43846 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
Choose this code for the short-limb Roux-en-Y configuration. Code 43847 describes bypass with additional small-intestinal reconstruction to limit absorption.
No office rate
Code 43845 describes a duodenal-switch reconstruction, not the short-limb Roux-en-Y gastric bypass reported here.
No office rate
Code 43848 describes revision of an open gastric restrictive procedure. It is not the code for the primary short-limb bypass operation.
Compare 43846 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$1485.28
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 43846 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,309
- Code
- 43846
- Physician work
- 26.72
- Practice expense
- 12.45
- Malpractice
- 7.16
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.72 | × 1.000 | 26.7200 |
| Practice expense | 12.45 | × 1.000 | 12.4500 |
| Malpractice | 7.16 | × 0.740 | 5.2984 |
| Total RVUs | 44.4684 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$1485.28
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.72 | 1 |
| Practice expense | 12.45 | 1 |
| Malpractice | 7.16 | 0.74 |
(26.72 × 1 + 12.45 × 1 + 7.16 × 0.74) × $33.4009 = $1485.28
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.
43846 billing questions
How does this differ from 43847?
This code describes a short Roux limb under 150 cm. Code 43847 is for gastric bypass with additional small-intestinal reconstruction to limit absorption.
Can this be reported for a laparoscopic bypass?
No. For a laparoscopic gastric bypass with Roux-en-Y reconstruction, compare 43644. This code describes the open operation.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
Can an assistant surgeon be paid?
CMS allows payment for assistant-at-surgery services. Co-surgeon payment requires supporting documentation.
What documentation supports choosing this code?
The operative report should describe the gastric pouch, Roux-en-Y anatomy, open approach, and short limb length. These details distinguish it from longer-limb reconstruction and other bariatric procedures.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard 50% multiple-procedure reduction to the other procedures.
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.
5,30643842,,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
5,31143848,,Revj open gstr rstcv px,A,,31.93,13.40,NA,13.40,,8.32,53.65,53.65,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,31243860,,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
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,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,