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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the StomachCPT cpt-43635-gastric-resection-with-vagotomy
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    CPT 43635: Vagotomy with Distal Gastrectomy

    Medicare pays $101 on average nationally for this procedure.

    CPT code 43635 describes a surgical procedure in which the provider transects the vagus nerve (vagotomy) and removes the distal portion of the stomach (distal gastrectomy); this is an open abdominal surgical service generally rendered in an inpatient or operating room setting for management of peptic ulcer disease, refractory gastric pathology, or other surgical indications requiring gastric resection and vagal denervation.

    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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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with long-standing, medically refractory peptic ulcer disease and gastric outlet obstruction presents for definitive surgical management. The surgeon performs truncal vagotomy with antrectomy: the provider transects the vagus nerve and removes the distal portion of the stomach to reduce acid secretion and relieve obstruction. The typical workflow includes preoperative evaluation (history, physical, labs, endoscopy, imaging), informed consent discussing risks (bleeding, infection, leak, dumping syndrome), general anesthesia, operative time in an operating room with an open or laparoscopic approach as appropriate, intraoperative confirmation of adequate vagal transection and resection margins, gastrointestinal reconstruction (usually gastroduodenostomy or gastrojejunostomy), and postoperative monitoring in a PACU with transition to inpatient surgical floor care for pain control, nutrition advancement, and discharge planning. Typical site of service is an acute care inpatient hospital or ambulatory surgical center when clinically appropriate for minimally invasive approaches.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43631Truncal vagotomy and gastrojejunostomy, with antrectomy when performedOften performed as an alternative reconstructive approach; may be used when gastrojejunostomy is chosen for drainage.
    43633Vagotomy and antrectomy with gastrojejunostomy; limited or partial gastrectomyClosely related variant describing antrectomy with other reconstruction techniques.
    43842Partial gastrectomy with gastroduodenostomy (Billroth I)A common reconstruction performed after distal gastrectomy/antrectomy to restore continuity.
    43843Partial gastrectomy with gastrojejunostomy (Billroth II)Alternative reconstruction after antrectomy when gastroduodenostomy is not feasible.
    49560Repair of postoperative wound dehiscence (abdominal wall)Possible subsequent procedure for wound complications after abdominal surgery.

    Related Modifiers

    11 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…
    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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207K00000X
    207LP2900X
    207R00000X
    124Q00000X
    101YS0200X
    207PH0002X
    261QR0404X

    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-43622-TOTAL-GASTRECTOMY-ESOPHAGODUODENAL-POUCH-RECONSTRUCTION

    CPT 43622: Total Gastrectomy with Esophagoduodenostomy

    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

    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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