CPT code 44640: Fistula repair, bowel to skin2026 Medicare rate & RVUs in Missouri
Reports surgical closure of a communication between bowel and skin, such as a persistent enteric-draining opening in the abdominal wall.
CMS doesn’t publish an office rate for 44640 in Missouri.
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
On this page 9 sections
What 44640 covers
This code applies when a surgeon repairs an enterocutaneous fistula, an abnormal connection that lets bowel contents reach the skin. A typical presentation is persistent intestinal drainage through an abdominal wound or skin opening, often after prior abdominal surgery. General or colorectal surgeons usually perform the repair in an operating room, identifying the bowel-to-skin tract and closing the communication.
Select this code for a bowel-to-skin fistula, rather than a planned opening created as an enterostomy or a fistula involving another organ. The operative report should identify the fistula’s bowel and skin connection and describe the repair performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery 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 44640 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.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,260.59 |
| Metropolitan St. Louis, MO | Unavailable | $1,269.21 |
| Rest of Missouri | Unavailable | $1,235.84 |
How the 44640 rate is calculated
Each of 44640’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 · 44640
RVUs × geographic indexes × conversion factor
Work23.60
23.60 RVUs× 1.000 GPCI
Practice expense9.41
9.41 RVUs× 1.000 GPCI
Malpractice5.43
5.43 RVUs× 1.000 GPCI
Adjusted RVUs
38.4400
Conversion factor
$33.4009
Medicare rate
$1,283.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44640
44640 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44640
Fistula repair, bowel to skin
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 44640
Fistula repair, bowel to skin
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44640 without 51 · national facility
$1,283.93
Fistula repair, bowel to skin
44640-51 · Second procedure: 50%
$641.97
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%).
44640 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 44650Fistula repairIntestinal fistula
- Use 44640 for a bowel-to-skin fistula; 44650 is for an enterocolic fistula connecting bowel segments.
- 44660Bowel-bladder fistula repairWithout bowel resection
- Use 44660 for an enterovesical fistula involving the bladder when the repair is without intestinal or bladder resection.
- 44661Fistula repairWith bowel or bladder resection
- Use 44661 for an enterovesical fistula repair involving intestinal or bladder resection, rather than a bowel-to-skin fistula.
- 44620Stoma closureWithout resection and anastomosis
- Use 44620 to close a surgically created enterostomy; 44640 repairs an abnormal bowel-to-skin fistula.
44640 billing questions
When is 44640 appropriate?
Use it for surgical repair of a fistula connecting bowel to the skin, such as an enteric-draining abdominal wound. The operative documentation should establish that bowel-to-skin communication.
How is this different from closing an enterostomy?
An enterostomy is a surgically created bowel opening, while 44640 addresses an abnormal bowel-to-skin fistula. Consider 44620 for enterostomy closure.
What care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard 50% multiple-procedure reduction.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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
Fee sheets
Put 44640 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet