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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the StomachCPT cpt-43622-total-gastrectomy-esophagoduodenal-pouch-reconstruction
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    CPT 43622: Total Gastrectomy with Esophagoduodenostomy

    Medicare pays $2137 on average nationally for this procedure.

    CPT code 43622 describes a total gastrectomy in which the provider removes the entire stomach and constructs a direct pouch connecting the esophagus to the duodenum to maintain an uninterrupted alimentary tract; this is a major surgical abdominal procedure typically performed for gastric cancer and is usually provided in an inpatient hospital operating room setting with post‑operative inpatient care.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with biopsy-proven distal gastric adenocarcinoma presents with symptomatic gastric outlet obstruction and weight loss. After staging imaging shows localized disease without distant metastasis and a multidisciplinary tumor board recommends definitive surgical resection, the surgical team schedules a total gastrectomy with Roux-en-Y esophagojejunostomy reconstruction. The patient undergoes general anesthesia, perioperative antibiotics, and VTE prophylaxis. The operative workflow includes laparotomy (or laparoscopic-assisted approach), mobilization of the stomach, lymphadenectomy as indicated for oncologic margins, division of vascular supply, resection of the entire stomach, creation of a jejunal Roux limb, and construction of an esophagojejunostomy pouch to re-establish an uninterrupted alimentary tract. Postoperative care includes ICU or step-down monitoring for hemodynamic stability, early enteral nutrition via jejunostomy or nasoenteric tube if placed, pain control, and surveillance for complications such as anastomotic leak, bleeding, or pneumonia. Typical site of service is an inpatient acute care hospital; this is a major operative procedure performed by general surgeons specializing in surgical oncology or foregut surgery. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43280Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiplePreoperative diagnostic endoscopy to obtain gastric tumor biopsies and map tumor extent
    49000Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)May be performed at start of operation for diagnostic assessment and determination of resectability
    44120Enterolysis (lysis of adhesions), small intestinePerformed intraoperatively if dense adhesions are encountered during gastrectomy
    44320Small intestine resection and anastomosisRelevant when concurrent small bowel resection or jejunal conduit creation is documented
    49440Insertion of tunneled intraperitoneal catheter (peritoneal)May be used for postoperative drainage or chemotherapy port placement when indicated
    96567Chemo administration, intraperitoneal pump or catheter-related (example)Related to perioperative intraperitoneal treatments when clinically indicated

    Note: The above codes are commonly performed as part of the diagnostic, intraoperative, or postoperative management surrounding a total gastrectomy with Roux-en-Y reconstruction.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208C00000X
    207RH0000X
    2080P0205X
    207L00000X
    2084N0600X
    246QH0000X
    207RS0010X
    3336I0012X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-43605-OPEN-BIOPSY-EXCISION-GASTRIC-LESION

    CPT 43605: Open Biopsy and Excision of Gastric Lesion

    CPT-43610-GASTRIC-EXPLORATION-LESION-EXCISION

    CPT 43610: Exploration of Stomach and Excision of Lesion

    CPT-43611-GASTRIC-TUMOR-EXCISION-SURGICAL-ONCOLOGY

    CPT 43611: Excision of Cancerous Tumor of the Stomach

    CPT-43620-ESOPHAGOENTEROSTOMY-AFTER-GASTRECTOMY

    CPT 43620: Esophagojejunostomy After Gastrectomy

    CPT-43621-TOTAL-GASTRECTOMY-SMALL-BOWEL-ANASTOMOSIS

    CPT 43621: Total Gastrectomy with Small Bowel-to-Stomach Anastomosis

    CPT-43631-PARTIAL-GASTRECTOMY-GASTRODUODENOSTOMY

    CPT 43631: Partial Gastrectomy with Gastroduodenostomy (Billroth I)

    CPT-43632-PARTIAL-GASTRECTOMY-WITH-GASTROJEJUNOSTOMY

    CPT 43632: Partial Gastrectomy with Gastrojejunostomy

    CPT-43633-PARTIAL-GASTRECTOMY-STOMACH-RESECTION-RECONSTRUCTION

    CPT 43633: Distal Gastrectomy with Gastrojejunostomy

    CPT-43634-PARTIAL-GASTRECTOMY-WITH-INTESTINAL-POUCH-RECONSTRUCTION

    CPT 43634: Distal Gastrectomy with Intestinal Pouch Creation

    CPT-43635-GASTRIC-RESECTION-WITH-VAGOTOMY

    CPT 43635: Vagotomy with Distal Gastrectomy

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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