CPT code 44391: Colonoscopy through stoma, control of bleeding2026 Medicare rate & RVUs in California
Reports colonoscopy performed through a stoma to locate and treat a bleeding site using an endoscopic hemostasis method.
Medicare pays $749.72–$953.13 for 44391 in the office in California, from Chico, CA to San Benito County, CA. 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 44391 covers
A gastroenterologist or surgeon advances a colonoscope through a colostomy or other stoma to examine the colon and control active bleeding. The service includes endoscopic hemostasis, such as treatment of a bleeding lesion identified during the examination. It is typically performed in a hospital or ambulatory endoscopy facility when a patient with a stoma has gastrointestinal bleeding requiring endoscopic treatment.
Report this code when the colonoscopy reaches the colon through the stoma and bleeding is treated; documentation should identify the route, the bleeding site or source when found, and the hemostasis performed. It is not the code for a routine examination through a stoma or for treatment of a polyp instead of bleeding. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery, 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 44391 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 payment localities
$749.72 to $953.13
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $751.14 | $204.59 |
| Chico, CA | $749.72 | $203.17 |
| El Centro, CA | $749.80 | $203.25 |
| Fresno, CA | $749.72 | $203.17 |
| Hanford, CA | $749.72 | $203.17 |
| Los Angeles, CA | $802.96 | $213.03 |
| Madera, CA | $749.72 | $203.17 |
| Marin County, CA | $932.25 | $229.11 |
| Merced, CA | $749.72 | $203.17 |
| Modesto, CA | $749.72 | $203.17 |
| Napa, CA | $877.96 | $220.70 |
| Oxnard, CA | $800.02 | $210.58 |
| Redding, CA | $749.72 | $203.17 |
| Rest of California | $749.72 | $203.17 |
| Riverside, CA | $754.83 | $208.29 |
| Sacramento, CA | $789.24 | $209.28 |
| Salinas, CA | $786.36 | $208.40 |
| San Benito County, CA | $953.13 | $234.04 |
| San Diego, CA | $806.74 | $210.32 |
| San Francisco, CA | $931.71 | $228.58 |
| San Luis Obispo, CA | $773.45 | $205.46 |
| Santa Clara County, CA | $950.94 | $231.85 |
| Santa Cruz, CA | $815.92 | $210.03 |
| Santa Maria, CA | $789.82 | $208.37 |
| Santa Rosa, CA | $824.30 | $211.93 |
| Stockton, CA | $749.72 | $203.17 |
| Vallejo, CA | $877.19 | $219.93 |
| Visalia, CA | $749.72 | $203.17 |
| Yuba City, CA | $749.72 | $203.17 |
How the 44391 rate is calculated
Each of 44391’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 · 44391
RVUs × geographic indexes × conversion factor
Work4.02
4.02 RVUs× 1.000 GPCI
Practice expense16.52
16.52 RVUs× 1.000 GPCI
Malpractice0.47
0.47 RVUs× 1.000 GPCI
Adjusted RVUs
21.0100
Conversion factor
$33.4009
Medicare rate
$701.75
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44391
The CMS indicators that decide how 44391 is paid alongside other services.
CMS payment indicators · 44391
Colonoscopy through stoma, control of bleeding
| 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) | 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
44391 without 51 · national office
$701.75
Colonoscopy through stoma, control of bleeding
44391-51 · Second procedure: 50%
$350.88
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%).
44391 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 44388ColonoscopyDiagnostic, through stoma
- 44388 describes colonoscopy through a stoma without a therapeutic intervention. Choose 44391 when the endoscopist controls bleeding during the procedure.
- 44389ColonoscopyThrough stoma, with biopsy
- 44389 is for biopsy through a stoma; 44391 is for endoscopic control of bleeding. A biopsy alone does not establish bleeding control.
- 44392Stoma colonoscopyHot biopsy forceps removal
- 44392 covers removal of a lesion through a stoma using specified methods. Use 44391 when the treated problem is bleeding and the service is hemostasis.
- 45382ColonoscopyControl of bleeding
- Both codes describe colonoscopic bleeding control. 44391 is for access through a stoma; 45382 applies when the colon is approached by the route covered by that code.
44391 billing questions
How is this different from colonoscopy through a stoma without a therapeutic intervention?
Use 44391 when the endoscopist controls bleeding during the examination. A diagnostic examination through a stoma without bleeding control is represented by 44388.
Can a diagnostic colonoscopy through the stoma be reported separately?
The examination used to locate and treat the bleeding is part of the therapeutic service. When related endoscopies are performed together, CMS endoscopy family pricing applies.
Can modifier 50 be added for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
Can an assistant surgeon or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 44391?
Document that the colonoscope entered through the stoma, the bleeding site or source when identified, and the method used to control bleeding.
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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