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Billing code 44365: Small bowel endoscopyMedicare rate & RVUs

Reports small-bowel enteroscopy beyond the second portion of the duodenum when a tumor, polyp, or other lesion is removed using hot biopsy forceps or bipolar cautery.

CMS RVU26DEffective Oct 1, 2026109 payment localities295 Medicare services in 2024

Medicare pays $160.99 for 44365 nationally in a facility.

Medicare rate · 44365

Small bowel endoscopy

Swap in your local Medicare rate.

Work RVUs
3.13
Total RVUs
4.82
Global days
000

National rate · 2026

$160.99

Facility setting, before claim adjustments.

See every locality for 44365 → · 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 44365 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 44365 covers

A gastroenterologist or surgeon uses an enteroscope to examine the small bowel beyond the second portion of the duodenum and remove a tumor, polyp, or other lesion with hot biopsy forceps or bipolar cautery. This therapeutic procedure is commonly performed in a hospital outpatient department or ambulatory surgery center to evaluate and treat a lesion identified during small-bowel examination.

Choose this code when the documented removal technique is hot biopsy forceps or bipolar cautery; snare removal and ablation have distinct codes in the endoscopy family. The report should identify the small-bowel extent examined, the lesion treated, and the technique used. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are 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 44365 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

44365 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$150.32
Alaska*Unavailable$210.93
ArizonaUnavailable$157.92
ArkansasUnavailable$149.01
AtlantaUnavailable$164.37
AustinUnavailable$162.46
BakersfieldUnavailable$162.70
Baltimore/Surr. CntysUnavailable$168.70
BeaumontUnavailable$156.13
BrazoriaUnavailable$158.85

44365 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
44365 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 44365 rate is calculated

Each of 44365’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 · 44365

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.13Practice expense 1.34Malpractice 0.35

4.8200 adjusted RVUs×$33.4009 conversion factor=$160.99

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

Payment rules and modifiers for 44365

The CMS indicators that decide how 44365 is paid alongside other services.

CMS payment indicators · 44365

Small bowel endoscopy

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

44365 without 51 · national facility

$160.99

Small bowel endoscopy

44365-51 · Second procedure: 50%

$80.50

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

44365 compared with similar codes

Compare codes

44365 vs 44364 vs 44366 vs 44361 vs 44360: national Medicare rates

Swap in your local Medicare rate.

  • 44365
    Small bowel endoscopy · 3.13 wRVU
    —
  • 44364
    Small-bowel endoscopy · 3.54 wRVU
    —
  • 44366
    Enteroscopy hemostasis · 4.19 wRVU
    —
  • 44361
    Small bowel endoscopy · 2.7 wRVU
    —
  • 44360
    Small-bowel exam · 2.43 wRVU
    —

How to choose

44364Small-bowel endoscopy
44364 is for small-bowel lesion removal by snare. Use 44365 when hot biopsy forceps or bipolar cautery is the documented removal technique.
44366Enteroscopy hemostasis
44366 describes ablation of a lesion not amenable to removal with hot biopsy forceps, bipolar cautery, or a snare; 44365 reports removal using cautery.
44361Small bowel endoscopy
44361 is for small-bowel enteroscopy with biopsy. 44365 is for removal of a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery.
44360Small-bowel exam
44360 reports diagnostic small-bowel enteroscopy. Choose 44365 when the encounter includes removal of a lesion by hot biopsy forceps or bipolar cautery.

Codes related to 44365

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

Codes related to 44365
CodeHow it relatesNational office range
Same family
44360Small-bowel examDiagnostic small-bowel enteroscopy without the lesion-removal work reported with 44365.No office rate
44361Small bowel endoscopySmall-bowel enteroscopy with biopsy; 44365 describes lesion removal by cautery.No office rate
44363Small bowel endoscopySmall-bowel enteroscopy for control of bleeding, rather than lesion removal by cautery.No office rate
44364Small-bowel endoscopySmall-bowel lesion removal by snare rather than hot biopsy forceps or bipolar cautery.No office rate
44366Enteroscopy hemostasisSmall-bowel lesion ablation when the lesion is not amenable to removal by the listed techniques.No office rate
44370Small bowel endoscopySmall-bowel endoscopy with stent placement, a different therapeutic service.No office rate

44365 billing questions

Can a diagnostic small-bowel endoscopy also be billed separately?

When related endoscopies are performed together, CMS endoscopy family pricing applies. Document the therapeutic work and any other distinct endoscopic service performed.

What documentation supports reporting 44365?

Document the small-bowel extent examined, the lesion treated, and removal using hot biopsy forceps or bipolar cautery.

Should modifier 50 be reported for treatment on both sides?

No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.

Does the 0-day global period include same-day care?

Yes. Same-day preoperative and postoperative care is included in the 0-day global period.

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 44365PPRRVU2026_Oct_nonQPP.csv, line 5,393 (RVU26D)

Open CMS sourceHow we calculate rates

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