CPT code 44386: Pouch endoscopy, with biopsy2026 Medicare rate & RVUs in Missouri
Reports endoscopic examination of a surgically created small-intestinal pouch when one or more tissue biopsies are obtained during the procedure.
Medicare pays $307.12–$333.65 for 44386 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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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What 44386 covers
A gastroenterologist or colorectal surgeon uses an endoscope to examine a surgically created small-intestinal pouch, such as an ileal pouch or continent ileostomy reservoir, and takes tissue samples. The examination may assess symptoms or findings such as pouch inflammation, bleeding, or suspected Crohn disease. The route depends on the pouch anatomy: an ileal pouch may be reached through the anus, while a continent reservoir may be entered through its stoma.
Report this code when the pouch examination includes one or more biopsies; the number of samples does not create additional units. Document the pouch examined, the endoscopic findings, and biopsy sites or specimens. The procedure has a 0-day global period, so same-day preoperative and postoperative care are included. If multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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 44386 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$307.12 to $333.65
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $329.70 | $79.42 |
| Metropolitan St. Louis, MO | $333.65 | $79.91 |
| Rest of Missouri | $307.12 | $77.37 |
How the 44386 rate is calculated
Each of 44386’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 · 44386
RVUs × geographic indexes × conversion factor
Work1.46
1.46 RVUs× 1.000 GPCI
Practice expense8.77
8.77 RVUs× 1.000 GPCI
Malpractice0.18
0.18 RVUs× 1.000 GPCI
Adjusted RVUs
10.4100
Conversion factor
$33.4009
Medicare rate
$347.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44386
The CMS indicators that decide how 44386 is paid alongside other services.
CMS payment indicators · 44386
Pouch endoscopy, with 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
44386 without 51 · national office
$347.70
Pouch endoscopy, with biopsy
44386-51 · Second procedure: 50%
$173.85
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%).
44386 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44385Pouch endoscopyWithout tissue biopsy
- Both address endoscopic examination of a surgically created small-intestinal pouch. Choose 44386 when biopsy is performed; 44385 is for examination without biopsy.
- 44388ColonoscopyDiagnostic, through stoma
- 44388 describes colonoscopy through a stoma, rather than endoscopic examination of a small-intestinal pouch.
- 44389ColonoscopyThrough stoma, with biopsy
- 44389 is colonoscopy through a stoma with biopsy. Use 44386 when the examined structure is a surgically created small-intestinal pouch.
44386 billing questions
How does this differ from 44385?
Use 44386 when the pouch endoscopy includes biopsy. Code 44385 describes pouch endoscopy without biopsy.
Can multiple biopsy samples be reported as multiple units?
No. This code covers the pouch examination with one or more biopsies; multiple samples during the same procedure do not make multiple units.
Is biopsy included in the service?
Yes. The pouch examination and biopsy are represented together by this code. A separate pathology service may be reported by the provider who performs the tissue analysis.
Should modifier 50 be appended?
No. The pouch anatomy makes bilateral adjustment inappropriate, so modifier 50 is not appropriate for this service.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
How does the multiple-procedure reduction work?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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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