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Billing code 44121: Small bowel resectionMedicare rate & RVUs

Reports an additional small-intestine segment resection with anastomosis performed during an operative session that includes the primary resection.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.7K Medicare services in 2024

Medicare pays $216.44 for 44121 nationally in a facility.

Medicare rate · 44121

Small bowel resection

Swap in your local Medicare rate.

Work RVUs
4.33
Total RVUs
6.48
Global days
ZZZ

National rate · 2026

$216.44

Facility setting, before claim adjustments.

See every locality for 44121 → · 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 44121 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 44121 covers

This add-on describes another small-intestine segment resection with an anastomosis during the same operative session as the primary resection. A surgeon may perform it when separate diseased segments require individual removal and reconnection, such as in a patient with more than one affected area of bowel. It distinguishes an additional resection and anastomosis from simply removing a longer continuous segment.

Report 44121 with the applicable primary procedure, not by itself. The operative report should establish that an additional segment was resected and anastomosed, beyond the resection represented by the primary code. CMS treats this as an add-on code: payment is handled within the primary procedure’s global period. The primary procedure and the additional work should be identifiable in the operative documentation.

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 44121 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

44121 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$196.42
Alaska*Unavailable$275.05
ArizonaUnavailable$210.17
ArkansasUnavailable$194.02
AtlantaUnavailable$224.63
AustinUnavailable$214.75
BakersfieldUnavailable$208.67
Baltimore/Surr. CntysUnavailable$229.86
BeaumontUnavailable$210.65
BrazoriaUnavailable$209.41

44121 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
44121 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 44121 rate is calculated

Each of 44121’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 · 44121

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 4.33Practice expense 1.08Malpractice 1.07

6.4800 adjusted RVUs×$33.4009 conversion factor=$216.44

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

Payment rules and modifiers for 44121

The CMS indicators that decide how 44121 is paid alongside other services.

CMS payment indicators · 44121

Small bowel resection

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

44121 without 80 · national facility

$216.44

Small bowel resection

44121-80 · Assistant: 16%

$34.63

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

44121 compared with similar codes

Compare codes

44121 vs 44120 vs 44125 vs 44203: national Medicare rates

Swap in your local Medicare rate.

  • 44121
    Small bowel resection · 4.33 wRVU
    —
  • 44120
    Small-bowel resection · 20.3 wRVU
    —
  • 44125
    Small-bowel resection · 19.53 wRVU
    —
  • 44203
    Small bowel resection · 4.33 wRVU
    —

How to choose

44120Small-bowel resection
44120 reports the primary small-intestine resection with anastomosis. Use 44121 only for an additional resection and anastomosis in the same operative session.
44125Small-bowel resection
44125 describes a small-intestine resection with enterostomy. 44121 is for additional resection work with anastomosis.
44203Small bowel resection
44203 is the laparoscopic add-on for additional small-intestine resection and anastomosis; 44121 is the corresponding add-on for the open procedure.

Codes related to 44121

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

Codes related to 44121
CodeHow it relatesNational office range
Add-on codes
44120Small-bowel resectionPrimary small-intestine resection code associated with an additional resection and anastomosis.No office rate
Used instead
44125Small-bowel resectionSmall-intestine resection with enterostomy rather than the additional anastomosis described here.No office rate
44203Small bowel resectionLaparoscopic counterpart for an additional small-intestine resection and anastomosis.No office rate

44121 billing questions

When is 44121 reported with 44120?

Use 44121 for an additional small-intestine resection and anastomosis beyond the primary resection reported with 44120. The additional work must be documented in the operative report.

Can 44121 be billed by itself?

No. It is an add-on code and must be reported with an applicable primary procedure.

Does a longer single resection support 44121?

Not by itself. The documentation should show another resection and anastomosis, rather than only a longer continuous segment removed as part of the primary resection.

How does 44121 differ from 44125?

44121 represents an additional resection with anastomosis. 44125 describes a small-intestine resection with an enterostomy, a different reconstruction.

How is 44121 paid in relation to the primary procedure?

CMS identifies it as an add-on code paid within the primary procedure’s global period. It cannot be reported without the primary procedure.

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 44121PPRRVU2026_Oct_nonQPP.csv, line 5,336 (RVU26D)

Open CMS sourceHow we calculate rates

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