CPT code 44365: Small bowel endoscopy, hot forceps or bipolar cautery2026 Medicare rate & RVUs in California
Reports small-bowel enteroscopy beyond the second portion of the duodenum when a tumor, polyp, or other lesion is removed using hot biopsy forceps or bipolar cautery.
CMS doesn’t publish an office rate for 44365 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 44365 covers
A gastroenterologist or surgeon uses an enteroscope to examine the small bowel beyond the second portion of the duodenum and remove a tumor, polyp, or other lesion with hot biopsy forceps or bipolar cautery. This therapeutic procedure is commonly performed in a hospital outpatient department or ambulatory surgery center to evaluate and treat a lesion identified during small-bowel examination.
Choose this code when the documented removal technique is hot biopsy forceps or bipolar cautery; snare removal and ablation have distinct codes in the endoscopy family. The report should identify the small-bowel extent examined, the lesion treated, and the technique used. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 44365 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 | $162.70 |
| Chico, CA | Unavailable | $161.64 |
| El Centro, CA | Unavailable | $161.70 |
| Fresno, CA | Unavailable | $161.64 |
| Hanford, CA | Unavailable | $161.64 |
| Los Angeles, CA | Unavailable | $169.54 |
| Madera, CA | Unavailable | $161.64 |
| Marin County, CA | Unavailable | $182.95 |
| Merced, CA | Unavailable | $161.64 |
| Modesto, CA | Unavailable | $161.64 |
| Napa, CA | Unavailable | $176.06 |
| Oxnard, CA | Unavailable | $167.66 |
| Redding, CA | Unavailable | $161.64 |
| Rest of California | Unavailable | $161.64 |
| Riverside, CA | Unavailable | $165.45 |
| Sacramento, CA | Unavailable | $166.63 |
| Salinas, CA | Unavailable | $165.93 |
| San Benito County, CA | Unavailable | $186.85 |
| San Diego, CA | Unavailable | $167.55 |
| San Francisco, CA | Unavailable | $182.55 |
| San Luis Obispo, CA | Unavailable | $163.57 |
| Santa Clara County, CA | Unavailable | $185.23 |
| Santa Cruz, CA | Unavailable | $167.39 |
| Santa Maria, CA | Unavailable | $165.92 |
| Santa Rosa, CA | Unavailable | $168.91 |
| Stockton, CA | Unavailable | $161.64 |
| Vallejo, CA | Unavailable | $175.49 |
| Visalia, CA | Unavailable | $161.64 |
| Yuba City, CA | Unavailable | $161.64 |
How the 44365 rate is calculated
Each of 44365’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 · 44365
RVUs × geographic indexes × conversion factor
Work3.13
3.13 RVUs× 1.000 GPCI
Practice expense1.34
1.34 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
4.8200
Conversion factor
$33.4009
Medicare rate
$160.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44365
The CMS indicators that decide how 44365 is paid alongside other services.
CMS payment indicators · 44365
Small bowel endoscopy, hot forceps or bipolar cautery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44365 without 51 · national facility
$160.99
Small bowel endoscopy, hot forceps or bipolar cautery
44365-51 · Second procedure: 50%
$80.50
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%).
44365 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 44364Small-bowel endoscopySnare lesion removal
- 44364 is for small-bowel lesion removal by snare. Use 44365 when hot biopsy forceps or bipolar cautery is the documented removal technique.
- 44366Enteroscopy hemostasisBleeding control, no ileum
- 44366 describes ablation of a lesion not amenable to removal with hot biopsy forceps, bipolar cautery, or a snare; 44365 reports removal using cautery.
- 44361Small bowel endoscopyBiopsy, ileum excluded
- 44361 is for small-bowel enteroscopy with biopsy. 44365 is for removal of a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery.
- 44360Small-bowel examDiagnostic, without biopsy
- 44360 reports diagnostic small-bowel enteroscopy. Choose 44365 when the encounter includes removal of a lesion by hot biopsy forceps or bipolar cautery.
44365 billing questions
Can a diagnostic small-bowel endoscopy also be billed separately?
When related endoscopies are performed together, CMS endoscopy family pricing applies. Document the therapeutic work and any other distinct endoscopic service performed.
What documentation supports reporting 44365?
Document the small-bowel extent examined, the lesion treated, and removal using hot biopsy forceps or bipolar cautery.
Should modifier 50 be reported for treatment on both sides?
No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
Does the 0-day global period include same-day care?
Yes. Same-day preoperative and postoperative care is included in the 0-day global period.
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
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