CPT code 44650: Fistula repair, intestinal fistula2026 Medicare rate & RVUs in Missouri
Reports operative repair of an intestinal fistula, with code selection guided by the fistula’s anatomy and the specific work documented in the operative report.
CMS doesn’t publish an office rate for 44650 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.
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On this page 9 sections
What 44650 covers
CPT 44650 describes operative repair of an abnormal tract involving intestine and another bowel segment or an adjacent structure. A general or colorectal surgeon typically performs the repair in a hospital operating room, identifying the tract and repairing the involved bowel opening or openings. The operative report should establish the fistula’s origin and destination and describe the repair performed.
Select the code based on the documented anatomy and procedure, not merely the diagnosis of a fistula. Use the more specific fistula codes when the connection is between bowel and skin or bowel and bladder. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this service.
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 44650 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 | $1,299.50 |
| Metropolitan St. Louis, MO | Unavailable | $1,308.27 |
| Rest of Missouri | Unavailable | $1,274.18 |
How the 44650 rate is calculated
Each of 44650’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 · 44650
RVUs × geographic indexes × conversion factor
Work24.49
24.49 RVUs× 1.000 GPCI
Practice expense9.63
9.63 RVUs× 1.000 GPCI
Malpractice5.50
5.50 RVUs× 1.000 GPCI
Adjusted RVUs
39.6200
Conversion factor
$33.4009
Medicare rate
$1,323.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44650
44650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44650
Fistula repair, intestinal fistula
| 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 · 44650
Fistula repair, intestinal fistula
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
44650 without 51 · national facility
$1,323.34
Fistula repair, intestinal fistula
44650-51 · Second procedure: 50%
$661.67
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%).
44650 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44640Fistula repairBowel to skin
- 44640 is specific to a fistula connecting bowel and skin. Choose 44650 for other intestinal fistula anatomy when a more specific fistula code does not describe the repair.
- 44660Bowel-bladder fistula repairWithout bowel resection
- 44660 describes enterovesical fistula closure without intestinal or bladder resection; it is more specific than 44650 for that anatomy.
- 44661Fistula repairWith bowel or bladder resection
- 44661 describes enterovesical fistula closure when intestinal and/or bladder resection is performed. The bowel-to-bladder connection and resection distinguish it from 44650.
44650 billing questions
When should 44650 be chosen over 44640?
Use 44650 for an intestinal fistula that is not an enterocutaneous fistula. When the tract connects bowel to skin, 44640 is the more specific code.
How does 44650 differ from 44660 or 44661?
For an enterovesical fistula, use the specific bowel-to-bladder code: 44660 when repair is without intestinal or bladder resection, or 44661 when resection is performed.
What documentation supports 44650?
Document the fistula’s origin and destination, the bowel segments or adjacent structures involved, and the operative steps used to repair it. Include any resection performed.
Can modifier 50 be appended?
No. Modifier 50 is inappropriate for this intestinal fistula repair.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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
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