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Billing code 44005: Bowel adhesiolysisMedicare rate & RVUs

Open adhesiolysis frees bowel from adhesions causing tethering or obstruction when the surgeon performs the work as a distinct abdominal procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities7.1K Medicare services in 2024

Medicare pays $1,020.40 for 44005 nationally in a facility.

Medicare rate · 44005

Bowel adhesiolysis

Swap in your local Medicare rate.

Work RVUs
18
Total RVUs
30.55
Global days
090

National rate · 2026

$1,020.40

Facility setting, before claim adjustments.

See every locality for 44005 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 44005 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 44005 covers

The surgeon reaches the abdominal cavity through an incision and carefully divides adhesions that tether or obstruct the bowel. General surgeons commonly perform this in a hospital operating room when adhesions are the focus of treatment, such as in a patient with adhesive small-bowel obstruction. This code represents open surgery; laparoscopic freeing of bowel adhesions is reported with a different code.

Report 44005 when the adhesiolysis is a distinct procedure, rather than routine release of adhesions needed to expose or complete another abdominal operation. The operative note should describe the adhesions, the bowel involved, and the work performed to free it. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. 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. Modifier 50 is not appropriate for this unpaired bowel procedure. 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 44005 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

44005 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$921.14
Alaska*Unavailable$1,270.31
ArizonaUnavailable$990.27
ArkansasUnavailable$909.13
AtlantaUnavailable$1,056.96
AustinUnavailable$1,019.83
BakersfieldUnavailable$998.21
Baltimore/Surr. CntysUnavailable$1,085.49
BeaumontUnavailable$985.55
BrazoriaUnavailable$989.44

44005 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
44005 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 44005 rate is calculated

Each of 44005’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 · 44005

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.00Practice expense 8.01Malpractice 4.54

30.5500 adjusted RVUs×$33.4009 conversion factor=$1,020.40

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 44005

44005 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 44005

Bowel adhesiolysis

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 44005

Bowel adhesiolysis

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

44005 without 51 · national facility

$1,020.40

Bowel adhesiolysis

44005-51 · Second procedure: 50%

$510.20

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%).

When to use modifier 51

44005 compared with similar codes

Compare codes

44005 vs 44180 vs 44120 vs 44050: national Medicare rates

Swap in your local Medicare rate.

  • 44005
    Bowel adhesiolysis · 18 wRVU
    —
  • 44180
    Adhesion release · 14.89 wRVU
    —
  • 44120
    Small-bowel resection · 20.3 wRVU
    —
  • 44050
    Bowel obstruction reduction · 15.13 wRVU
    —

How to choose

44180Adhesion release
Choose 44005 for open adhesiolysis and 44180 when the surgeon frees bowel adhesions laparoscopically.
44120Small-bowel resection
44005 frees bowel from adhesions; 44120 removes a segment of small intestine and reconnects the bowel.
44050Bowel obstruction reduction
44005 addresses bowel tethering from adhesions. 44050 is for open reduction of obstruction from a different mechanical cause.

Codes related to 44005

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 44005
CodeHow it relatesNational office range
Used instead
44180Adhesion releaseLaparoscopic approach to freeing bowel adhesions.No office rate
44120Small-bowel resectionSmall-bowel resection when diseased or damaged bowel must be removed.No office rate
44050Bowel obstruction reductionOpen reduction for bowel obstruction caused by a different mechanical problem.No office rate

44005 billing questions

How does 44005 differ from 44180?

44005 is the open approach to freeing bowel adhesions. 44180 describes laparoscopic enterolysis.

Can modifier 50 be used for adhesions on both sides of the abdomen?

No. The procedure is not a paired-side service, so modifier 50 is not appropriate.

Is postoperative care included in 44005?

Yes. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

What happens when 44005 is performed with another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure 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

Show the CMS file lines behind this rate
RVUs for 44005PPRRVU2026_Oct_nonQPP.csv, line 5,323 (RVU26D)

Open CMS sourceHow we calculate rates

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