CPT code 44661: Fistula repair, with bowel or bladder resection2026 Medicare rate & RVUs in Texas
Reports operative repair of a bowel-to-bladder fistula when the surgeon resects involved intestine, bladder tissue, or both as part of treatment.
CMS doesn’t publish an office rate for 44661 in Texas.
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 44661 covers
This service treats an abnormal connection between the intestine and bladder when repair requires removal of involved bowel or bladder tissue. A colorectal or general surgeon commonly performs the intestinal portion, sometimes with a urologist participating in bladder repair. Typical cases include a colovesical fistula associated with diverticular disease, inflammatory bowel disease, or a tumor. The operation may involve separating the organs, removing the diseased segment, and repairing the remaining tissue.
Select this code when the operative report documents fistula repair with resection of intestine, bladder, or both; use the non-resection sibling when repair is completed without either resection. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires 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 44661 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 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $1,412.90 |
| Beaumont, TX | Unavailable | $1,370.78 |
| Brazoria, TX | Unavailable | $1,375.59 |
| Dallas, TX | Unavailable | $1,393.29 |
| Fort Worth, TX | Unavailable | $1,392.53 |
| Galveston, TX | Unavailable | $1,385.58 |
| Houston, TX | Unavailable | $1,492.11 |
| Rest of Texas | Unavailable | $1,378.56 |
How the 44661 rate is calculated
Each of 44661’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 · 44661
RVUs × geographic indexes × conversion factor
Work26.67
26.67 RVUs× 1.000 GPCI
Practice expense9.85
9.85 RVUs× 1.000 GPCI
Malpractice5.82
5.82 RVUs× 1.000 GPCI
Adjusted RVUs
42.3400
Conversion factor
$33.4009
Medicare rate
$1,414.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44661
44661 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44661
Fistula repair, with bowel or bladder resection
| 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 · 44661
Fistula repair, with bowel or bladder resection
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
44661 without 51 · national facility
$1,414.19
Fistula repair, with bowel or bladder resection
44661-51 · Second procedure: 50%
$707.10
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%).
44661 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44660Bowel-bladder fistula repairWithout bowel resection
- Both codes address a bowel-bladder fistula. Choose 44661 when the repair includes resection of intestine, bladder tissue, or both; choose 44660 when it does not.
- 44650Fistula repairIntestinal fistula
- This code is for a bowel fistula repair without the bowel-to-bladder connection that defines 44661.
- 44640Fistula repairBowel to skin
- This code addresses a bowel-to-skin fistula. Use 44661 for a tract connecting bowel and bladder when the repair includes resection.
44661 billing questions
How does 44661 differ from 44660?
Use 44661 when the fistula repair includes resection of involved intestine, bladder tissue, or both. Use 44660 when the repair is performed without either resection.
Can the bowel or bladder resection be billed separately?
The resection that is part of the fistula repair is included in the service represented by 44661. Do not separately report that same resection as an independent procedure.
What should the operative report document?
Document the bowel-to-bladder connection, the repair performed, and whether intestine, bladder tissue, or both were resected. The report should make clear that resection was part of treating the fistula.
Should modifier 50 be used?
No. Modifier 50 is inappropriate for this repair; the anatomy is not reported as a bilateral service.
How are other procedures in the same session paid?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. The 90-day global period includes related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services 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
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