CPT 43845
Global 090 ActiveGastroplasty duodenal switch
CPT 43845 Billing & Documentation Guide
CPT code 43845 (Gastroplasty duodenal switch) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 32.47, a non-facility practice expense RVU of 13.66, and a malpractice RVU of 8.57, a total non-facility RVU of 54.7 and facility RVU of 54.7. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1827.86, though rates vary from $1609.78 to $2283.41 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 43845, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 43845 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 43845 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 43845
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 32.47 | 32.47 |
| Practice Expense RVU | 13.66 | 13.66 |
| Malpractice RVU | 8.57 | 8.57 |
| Total RVU | 54.7 | 54.7 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 43845
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1818.5 | $1818.5 | $1756.45 - $2015.17 | 29 |
| Florida | $2099.53 | $2099.53 | $1950.94 - $2283.41 | 3 |
| Georgia | $1863.92 | $1863.92 | $1832.71 - $1895.12 | 2 |
| Illinois | $2076.2 | $2076.2 | $1948.49 - $2207.59 | 4 |
| Michigan | $1915.84 | $1915.84 | $1824.26 - $2007.42 | 2 |
| North Carolina | $1693.13 | $1693.13 | $1693.13 - $1693.13 | 1 |
| New York | $2034.11 | $2034.11 | $1719.2 - $2227.98 | 5 |
| Ohio | $1789.62 | $1789.62 | $1789.62 - $1789.62 | 1 |
| Pennsylvania | $1847.19 | $1847.19 | $1773.87 - $1920.5 | 2 |
| Texas | $1805.56 | $1805.56 | $1765.64 - $1940.14 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 43845
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 43845 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00797 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0392T | Column 1 (primary), can be billed with modifier | Yes | More extensive procedure |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0652T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 43845
What does CPT code 43845 mean? +
CPT code 43845 represents: Gastroplasty duodenal switch. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 43845? +
The 2026 Medicare national average non-facility payment for CPT 43845 is $1827.86. Rates range from $1609.78 to $2283.41 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 43845? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 43845? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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