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    v1.0.30
    OpenPayerBilling CodesLaparoscopic Procedures on the StomachCPT cpt-43652-laparoscopic-selective-highly-selective-vagotomy
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    CPT 43652: Laparoscopic Selective or Highly Selective Vagotomy

    Medicare pays $739 on average nationally for this procedure.

    CPT code 43652 describes a laparoscopic selective or highly selective vagotomy performed to denervate the stomach (division of the anterior and posterior gastric nerves of Latarjet only or denervation limited to the fundus and body), which is a surgical abdominal procedure typically performed in an inpatient or outpatient hospital operating room setting using minimally invasive (laparoscopic) technique.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old patient with chronic, refractory peptic ulcer disease and complications from acid hypersecretion is evaluated for surgical management after failing maximal medical therapy including proton pump inhibitors and H. pylori eradication when applicable. Workup includes upper endoscopy, gastric emptying assessment if indicated, and preoperative surgical clearance. The patient is scheduled for a laparoscopic selective or highly selective vagotomy (43652) performed by a general surgeon with advanced foregut expertise. Intraoperative workflow involves induction of general anesthesia, laparoscopic access with trocars, identification of the vagal trunks and gastric branches, selective division of the anterior and posterior gastric nerves of Latarjet only or denervation limited to fundus and body (parietal cell–containing areas) depending on surgical intent, hemostasis confirmation, and closure of port sites. Typical perioperative documentation includes operative report detailing technique (selective vs highly selective), targeted nerve branches, findings, estimated blood loss, complications, and disposition. Postoperative care includes pain control, diet advancement, monitoring for gastric emptying disturbance or reflux, and outpatient follow-up for symptom resolution and potential need for acid suppression therapy adjustments.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43235Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)Preoperative diagnostic endoscopy to evaluate peptic ulcer disease and anatomy prior to 43652.
    43280Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus, by balloon or bougiePerformed pre- or postoperatively for symptomatic strictures or dysphagia associated with peptic disease.
    43770Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (for obesity)Not directly related but contextually shares laparoscopic foregut operative workflows and instrumentation; listed for operative sequencing awareness.
    43846Revision, gastric restrictive procedure (e.g., repair of gastrojejunostomy)May be performed if prior gastric surgery complicates access for 43652; relevant when prior operations exist.
    49999Unlisted procedure, abdomen, peritoneum, omentumUsed rarely for atypical or adjunct laparoscopic maneuvers not described by standard codes during the same operative session.

    Related Modifiers

    8 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…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    207L00000X
    364S00000X
    332H00000X
    2084F0202X
    261QA3000X
    225XM0800X
    2085P0229X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-43644-LAPAROSCOPIC-GASTRIC-BYPASS-STOMACH-TO-JEJUNUM

    CPT 43644: Laparoscopic Gastric Bypass with Gastrojejunostomy

    CPT-43645-GASTRIC-BYPASS-SMALL-GASTRIC-RESERVOIR-ROUX-EN

    CPT 43645: Laparoscopic Roux-en-Y Gastric Bypass

    CPT-43647-LAPAROSCOPIC-GASTRIC-STIMULATION-ELECTRODE-PLACEMENT

    CPT 43647: Laparoscopic Gastric Stimulation Electrode Placement

    CPT-43648-LAPAROSCOPIC-GASTRIC-NEUROSTIMULATOR-ELECTRODE-MANAGEMENT

    CPT 43648: Laparoscopic Gastric Neurostimulator Revision or Removal

    CPT-43651-LAPAROSCOPIC-TRUNCAL-VAGOTOMY-FOR-DUODENAL-ULCER

    CPT 43651: Laparoscopic Truncal Vagotomy for Duodenal Ulcer

    CPT-43653-GASTRIC-TUBE-PLACEMENT-FOR-ENTERAL-ACCESS

    CPT 43653: Percutaneous Endoscopic Gastrostomy Tube Placement

    CPT-43659-UNLISTED-LAPAROSCOPIC-STOMACH-PROCEDURE

    CPT 43659: Laparoscopic Procedure on Stomach, Unlisted

    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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