CPT code 44121: Small bowel resection, each additional resection2026 Medicare rate & RVUs in California
Reports an additional small-intestine segment resection with anastomosis performed during an operative session that includes the primary resection.
CMS doesn’t publish an office rate for 44121 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 44121 covers
This add-on describes another small-intestine segment resection with an anastomosis during the same operative session as the primary resection. A surgeon may perform it when separate diseased segments require individual removal and reconnection, such as in a patient with more than one affected area of bowel. It distinguishes an additional resection and anastomosis from simply removing a longer continuous segment.
Report 44121 with the applicable primary procedure, not by itself. The operative report should establish that an additional segment was resected and anastomosed, beyond the resection represented by the primary code. CMS treats this as an add-on code: payment is handled within the primary procedure’s global period. The primary procedure and the additional work should be identifiable in the operative documentation.
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.
Where 44121 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $208.67 |
| Chico, CA | Unavailable | $205.78 |
| El Centro, CA | Unavailable | $205.96 |
| Fresno, CA | Unavailable | $205.78 |
| Hanford, CA | Unavailable | $205.78 |
| Los Angeles, CA | Unavailable | $216.96 |
| Madera, CA | Unavailable | $205.78 |
| Marin County, CA | Unavailable | $225.63 |
| Merced, CA | Unavailable | $205.78 |
| Modesto, CA | Unavailable | $205.78 |
| Napa, CA | Unavailable | $219.44 |
| Oxnard, CA | Unavailable | $213.58 |
| Redding, CA | Unavailable | $205.78 |
| Rest of California | Unavailable | $205.78 |
| Riverside, CA | Unavailable | $217.25 |
| Sacramento, CA | Unavailable | $210.94 |
| Salinas, CA | Unavailable | $210.07 |
| San Benito County, CA | Unavailable | $231.71 |
| San Diego, CA | Unavailable | $211.48 |
| San Francisco, CA | Unavailable | $224.42 |
| San Luis Obispo, CA | Unavailable | $207.33 |
| Santa Clara County, CA | Unavailable | $226.74 |
| Santa Cruz, CA | Unavailable | $210.65 |
| Santa Maria, CA | Unavailable | $209.89 |
| Santa Rosa, CA | Unavailable | $212.42 |
| Stockton, CA | Unavailable | $205.78 |
| Vallejo, CA | Unavailable | $217.69 |
| Visalia, CA | Unavailable | $205.78 |
| Yuba City, CA | Unavailable | $205.78 |
How the 44121 rate is calculated
Each of 44121’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 44121
RVUs × geographic indexes × conversion factor
Work4.33
4.33 RVUs× 1.000 GPCI
Practice expense1.08
1.08 RVUs× 1.000 GPCI
Malpractice1.07
1.07 RVUs× 1.000 GPCI
Adjusted RVUs
6.4800
Conversion factor
$33.4009
Medicare rate
$216.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44121
The CMS indicators that decide how 44121 is paid alongside other services.
CMS payment indicators · 44121
Small bowel resection, each additional resection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
44121 without 80 · national facility
$216.44
Small bowel resection, each additional resection
44121-80 · Assistant: 16%
$34.63
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
44121 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44120Small-bowel resectionSingle resection with anastomosis
- 44120 reports the primary small-intestine resection with anastomosis. Use 44121 only for an additional resection and anastomosis in the same operative session.
- 44125Small-bowel resectionWith enterostomy
- 44125 describes a small-intestine resection with enterostomy. 44121 is for additional resection work with anastomosis.
- 44203Small bowel resectionEach additional resection
- 44203 is the laparoscopic add-on for additional small-intestine resection and anastomosis; 44121 is the corresponding add-on for the open procedure.
44121 billing questions
When is 44121 reported with 44120?
Use 44121 for an additional small-intestine resection and anastomosis beyond the primary resection reported with 44120. The additional work must be documented in the operative report.
Can 44121 be billed by itself?
No. It is an add-on code and must be reported with an applicable primary procedure.
Does a longer single resection support 44121?
Not by itself. The documentation should show another resection and anastomosis, rather than only a longer continuous segment removed as part of the primary resection.
How does 44121 differ from 44125?
44121 represents an additional resection with anastomosis. 44125 describes a small-intestine resection with an enterostomy, a different reconstruction.
How is 44121 paid in relation to the primary procedure?
CMS identifies it as an add-on code paid within the primary procedure’s global period. It cannot be reported without the primary procedure.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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