CPT code 44385: Pouch endoscopy, without tissue biopsy2026 Medicare rate & RVUs in Texas
Endoscopic inspection of an ileal pouch is reported for evaluation when the examination does not include tissue biopsy.
Medicare pays $226.72–$256.22 for 44385 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
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 44385 covers
This service examines an ileal reservoir with an endoscope, such as a pouch created after restorative proctocolectomy. Gastroenterologists and colorectal surgeons commonly perform it to evaluate symptoms such as pouch-related inflammation, bleeding, or altered bowel function. The examination may include collecting cells or fluid by brushing or washing; those methods do not make it a biopsy service.
Report this code when the pouch is examined without tissue sampling. If the endoscopist takes tissue biopsies, use the related biopsy code instead. The report should identify the pouch examined, the examination findings, and any specimen collection method. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and 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 44385 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$226.72 to $256.22
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $256.22 | $68.22 |
| Beaumont, TX | $226.72 | $65.02 |
| Brazoria, TX | $242.42 | $66.33 |
| Dallas, TX | $243.91 | $66.92 |
| Fort Worth, TX | $241.98 | $66.77 |
| Galveston, TX | $243.10 | $66.65 |
| Houston, TX | $246.21 | $69.76 |
| Rest of Texas | $234.39 | $65.76 |
How the 44385 rate is calculated
Each of 44385’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 · 44385
RVUs × geographic indexes × conversion factor
Work1.17
1.17 RVUs× 1.000 GPCI
Practice expense6.00
6.00 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
7.3400
Conversion factor
$33.4009
Medicare rate
$245.16
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44385
The CMS indicators that decide how 44385 is paid alongside other services.
CMS payment indicators · 44385
Pouch endoscopy, without tissue biopsy
| 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 | 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) | 1 | Not paid (statutory restriction). |
| 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
44385 without 51 · national office
$245.16
Pouch endoscopy, without tissue biopsy
44385-51 · Second procedure: 50%
$122.58
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%).
44385 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44386Pouch endoscopyWith biopsy
- Both examine an ileal pouch. Choose 44385 when no tissue biopsy is taken; choose 44386 when one or more tissue biopsies are performed.
- 44388ColonoscopyDiagnostic, through stoma
- 44385 examines an ileal pouch. 44388 applies when the endoscope is used for colonoscopy through a stoma.
- 44389ColonoscopyThrough stoma, with biopsy
- 44389 is for colonoscopy through a stoma with biopsy. For biopsy of an ileal pouch, use 44386 instead.
44385 billing questions
When should 44385 be used instead of 44386?
Use 44385 for pouch examination without tissue biopsy, including when brushing or washing is performed. Use 44386 when tissue is sampled by biopsy.
Are brushing and washing included in 44385?
Yes. Specimen collection by brushing or washing, when performed during the pouch examination, is included in this service.
Is modifier 50 appropriate for pouch endoscopy?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the multiple-procedure reduction affect 44385?
When it is performed in the same session as other procedures, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
What care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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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