Billing code 44021: Bowel decompressionMedicare rate & RVUs

Medicare pays $908.84 for 44021 nationally in a facility.

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

What 44021 covers

A surgeon reports this service when the small intestine is surgically decompressed during an abdominal operation, such as for marked bowel distention associated with ileus or obstruction. The procedure may include an enterotomy to release gas or intestinal contents; that incision is part of the decompression service. It is distinct from simply inspecting the bowel or freeing adhesions without decompressing it. This code is generally associated with facility-based surgery.

The operative report should identify the small bowel as the site and describe the distention, the decompression performed, and whether an enterotomy was used. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. 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 44021 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

44021 rates by state

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

How the 44021 rate is calculated

Each of 44021’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.

Payment rules and modifiers for 44021

44021 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

44021 compared with similar codes

How to choose

44010Duodenotomy

Use 44021 when the small-bowel incision serves to decompress distended bowel. A small-bowel incision for another purpose belongs to the distinct incision service.

44020Small-bowel exploration

Exploration concerns inspection of the small intestine, with or without biopsy; 44021 requires actual decompression.

44050Bowel obstruction reduction

Choose 44050 when the operation reduces an obstruction. Choose 44021 when the documented service is decompression of the small bowel.

44005Bowel adhesiolysis

44005 describes freeing bowel adhesions. It does not describe decompression, though both procedures may be performed during the same operation.

Codes related to 44021

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

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

Open CMS sourceHow we calculate rates