FeeBase
Log inGet started
Menu

CPT code 44186: Jejunostomy, laparoscopic feeding access2026 Medicare rate & RVUs

Reports laparoscopic placement of a jejunostomy feeding tube when enteral nutrition must bypass the stomach or oral intake is inadequate.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.9K Medicare services in 2024

Medicare pays $624.93 for 44186 nationally in a facility.

Medicare rate · 44186

Jejunostomy, laparoscopic feeding access

Office or facility?

Work RVUs
10.12
Total RVUs
18.71
Global days
090

National rate · 2026

$624.93

Facility setting, before claim adjustments.

See every locality for 44186 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 44186 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 44186 covers

A surgeon uses laparoscopic access to create an opening into the jejunum and place a feeding tube for enteral nutrition. The procedure is used when a patient needs nutrition delivered to the small intestine, such as when gastric feeding is not suitable. It is generally performed in an operating room, commonly during a facility-based surgical admission.

Report this code when the operative record supports laparoscopic jejunostomy tube placement; distinguish it from a laparoscopic non-tube ileostomy or jejunostomy. Documentation should identify the approach, jejunal site, tube placement, and clinical reason for feeding access. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.

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 44186 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

44186 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$562.34
AlaskaUnavailable$768.12
ArizonaUnavailable$606.26
ArkansasUnavailable$554.72
Atlanta, GAUnavailable$646.54
Austin, TXUnavailable$627.37
Bakersfield, CAUnavailable$616.77
Baltimore area, MDUnavailable$665.47
Beaumont, TXUnavailable$600.75
Brazoria, TXUnavailable$606.80

44186 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
44186 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 44186 rate is calculated

Each of 44186’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 · 44186

RVUs × geographic indexes × conversion factor

Office or facility?

Work10.12

10.12 RVUs× 1.000 GPCI

Practice expense6.00

6.00 RVUs× 1.000 GPCI

Malpractice2.59

2.59 RVUs× 1.000 GPCI

Adjusted RVUs

18.7100

Conversion factor

$33.4009

Medicare rate

$624.93

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 44186

44186 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 44186

Jejunostomy, laparoscopic feeding access

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.84/0.07Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 44186

Jejunostomy, laparoscopic feeding access

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

44186 without 51 · national facility

$624.93

Jejunostomy, laparoscopic feeding access

44186-51 · Second procedure: 50%

$312.47

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%).

When to use modifier 51

44186 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 44186

    Jejunostomy, laparoscopic feeding access10.12 wRVU

    Not priced

  • 44187

    Laparoscopic ostomy, ileum or jejunum, non-tube16.97 wRVU

    Not priced

  • 44300

    Enterostomy tube, open bowel-to-skin access13.41 wRVU

    Not priced

  • 49440

    Gastrostomy placement, percutaneous, image-guided3.83 wRVU

    $788.26

How to choose

44187Laparoscopic ostomyIleum or jejunum, non-tube
Choose 44186 for laparoscopic jejunostomy with a feeding tube. Choose 44187 for a laparoscopic ileostomy or jejunostomy without a tube.
44300Enterostomy tubeOpen bowel-to-skin access
44300 represents enterostomy tube placement by a different operative approach. 44186 specifically represents laparoscopic placement of a feeding jejunostomy.
49440Gastrostomy placementPercutaneous, image-guided
49440 is percutaneous gastrostomy tube placement, not laparoscopic access to the jejunum. The procedure performed and the feeding site distinguish the codes.

Codes related to 44186

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 44186
CodeHow it relatesNational office range
Used instead
44187Laparoscopic ostomy, ileum or jejunum, non-tubeLaparoscopic ileostomy or jejunostomy without a feeding tube.No office rate
44300Enterostomy tube, open bowel-to-skin accessEnterostomy tube placement by an approach other than the laparoscopic service represented by 44186.No office rate
49440Gastrostomy placement, percutaneous, image-guidedPercutaneous gastrostomy tube placement when gastric access is appropriate.$690.21–$1,081.19

44186 billing questions

How does this differ from 44187?

44186 is for laparoscopic jejunostomy with feeding-tube placement. 44187 describes a laparoscopic ileostomy or jejunostomy without a tube.

Can the tube placement and jejunostomy opening be billed separately?

The laparoscopic feeding jejunostomy is the service represented by 44186. Do not separately report the access creation as another procedure when it is part of that same operative service.

What documentation supports 44186?

The operative report should establish the laparoscopic approach, the jejunal site, placement of a feeding tube, and the clinical need for jejunal feeding.

How is postoperative care handled?

The code has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment for this code.

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

Show the CMS file lines behind this rate
RVUs for 44186PPRRVU2026_Oct_nonQPP.csv, line 5,363 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 44186 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 44186 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist