CPT code 44157: Proctocolectomy, direct ileoanal anastomosis2026 Medicare rate & RVUs in Maryland
Reports open removal of the colon and rectum with direct connection of the ileum to the anus, including a diverting loop ileostomy.
CMS doesn’t publish an office rate for 44157 in Maryland.
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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On this page 9 sections
What 44157 covers
This operation removes the colon and rectum and joins the end of the ileum directly to the anus, without constructing an ileal reservoir. A diverting loop ileostomy is included. Colorectal surgeons commonly perform it for conditions such as ulcerative colitis or familial adenomatous polyposis when the rectum is also removed and an ileoanal connection is planned. The code describes an open operation, typically performed in a hospital operating room.
Select the code when the operative report supports removal of both colon and rectum and a direct ileoanal anastomosis; distinguish it from procedures that leave the rectum, create a reservoir, or end in a different type of ileostomy. Document the resection, reconstruction, and diversion performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate.
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 44157 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $2,175.99 |
| Rest of Maryland | Unavailable | $2,035.05 |
| Washington, DC area | Unavailable | $2,241.22 |
How the 44157 rate is calculated
Each of 44157’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 · 44157
RVUs × geographic indexes × conversion factor
Work34.81
34.81 RVUs× 1.000 GPCI
Practice expense17.01
17.01 RVUs× 1.000 GPCI
Malpractice9.32
9.32 RVUs× 1.000 GPCI
Adjusted RVUs
61.1400
Conversion factor
$33.4009
Medicare rate
$2,042.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44157
44157 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44157
Proctocolectomy, direct ileoanal anastomosis
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 44157
Proctocolectomy, direct ileoanal anastomosis
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44157 without 51 · national facility
$2,042.13
Proctocolectomy, direct ileoanal anastomosis
44157-51 · Second procedure: 50%
$1,021.07
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
44157 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 44158ColectomyIleoanal pouch reconstruction
- 44158 includes construction of an ileal reservoir for the ileoanal anastomosis; 44157 describes direct ileoanal anastomosis without a reservoir.
- 44155ColectomyWith proctectomy and ileostomy
- Both include total colectomy and proctectomy, but 44155 ends in an ileostomy rather than connecting ileum to the anus.
- 44150Total colectomyRectum retained; ileostomy or ileoproctostomy
- 44150 removes the colon without proctectomy. Choose 44157 when the rectum is also removed and an ileoanal anastomosis is performed.
- 44211ProctocolectomyIleoanal pouch reconstruction
- 44211 describes the laparoscopic approach for the corresponding total colectomy, proctectomy, and ileoanal anastomosis; 44157 is for the open operation.
44157 billing questions
When is this code chosen instead of 44158?
Use 44157 for a direct ileoanal connection without an ileal reservoir. When the surgeon constructs an ileal reservoir or pouch for the anal anastomosis, compare 44158.
Is the loop ileostomy separately reported?
No. The loop ileostomy used to divert the ileoanal anastomosis is included in this procedure.
How does 44157 differ from 44155?
44157 includes an ileoanal anastomosis and loop ileostomy. 44155 describes total colectomy with proctectomy ending in an ileostomy rather than an ileoanal anastomosis.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 does not describe this operation.
What supports reporting 44157?
The operative report should establish removal of the colon and rectum, direct ileoanal anastomosis, and any included loop ileostomy. It should also make clear whether a reservoir was constructed.
How are assistant and co-surgeon services handled?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
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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