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Billing code 44650: Fistula repairMedicare rate & RVUs

Reports operative repair of an intestinal fistula, with code selection guided by the fistula’s anatomy and the specific work documented in the operative report.

CMS RVU26DEffective Oct 1, 2026109 payment localities381 Medicare services in 2024

Medicare pays $1,323.34 for 44650 nationally in a facility.

Medicare rate · 44650

Fistula repair

Swap in your local Medicare rate.

Work RVUs
24.49
Total RVUs
39.62
Global days
090

National rate · 2026

$1,323.34

Facility setting, before claim adjustments.

See every locality for 44650 → · 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 44650 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 44650 covers

billing code 44650 describes operative repair of an abnormal tract involving intestine and another bowel segment or an adjacent structure. A general or colorectal surgeon typically performs the repair in a hospital operating room, identifying the tract and repairing the involved bowel opening or openings. The operative report should establish the fistula’s origin and destination and describe the repair performed.

Select the code based on the documented anatomy and procedure, not merely the diagnosis of a fistula. Use the more specific fistula codes when the connection is between bowel and skin or bowel and bladder. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this service.

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 44650 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

44650 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,203.41
Alaska*Unavailable$1,670.76
ArizonaUnavailable$1,286.92
ArkansasUnavailable$1,188.89
AtlantaUnavailable$1,367.87
AustinUnavailable$1,322.69
BakersfieldUnavailable$1,297.94
Baltimore/Surr. CntysUnavailable$1,403.45
BeaumontUnavailable$1,281.35
BrazoriaUnavailable$1,286.58

44650 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
44650 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 44650 rate is calculated

Each of 44650’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 · 44650

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 24.49Practice expense 9.63Malpractice 5.50

39.6200 adjusted RVUs×$33.4009 conversion factor=$1,323.34

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

Payment rules and modifiers for 44650

44650 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 44650

Fistula repair

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 · 44650

Fistula repair

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

44650 without 51 · national facility

$1,323.34

Fistula repair

44650-51 · Second procedure: 50%

$661.67

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

44650 compared with similar codes

Compare codes

44650 vs 44640 vs 44660 vs 44661: national Medicare rates

Swap in your local Medicare rate.

  • 44650
    Fistula repair · 24.49 wRVU
    —
  • 44640
    Fistula repair · 23.6 wRVU
    —
  • 44660
    Bowel-bladder fistula repair · 23.31 wRVU
    —
  • 44661
    Fistula repair · 26.67 wRVU
    —

How to choose

44640Fistula repair
44640 is specific to a fistula connecting bowel and skin. Choose 44650 for other intestinal fistula anatomy when a more specific fistula code does not describe the repair.
44660Bowel-bladder fistula repair
44660 describes enterovesical fistula closure without intestinal or bladder resection; it is more specific than 44650 for that anatomy.
44661Fistula repair
44661 describes enterovesical fistula closure when intestinal and/or bladder resection is performed. The bowel-to-bladder connection and resection distinguish it from 44650.

Codes related to 44650

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

Codes related to 44650
CodeHow it relatesNational office range
Used instead
44640Fistula repairUse for an enterocutaneous fistula connecting bowel and skin.No office rate
44660Bowel-bladder fistula repairUse for enterovesical fistula closure without intestinal or bladder resection.No office rate
44661Fistula repairUse for enterovesical fistula closure with intestinal and/or bladder resection.No office rate

44650 billing questions

When should 44650 be chosen over 44640?

Use 44650 for an intestinal fistula that is not an enterocutaneous fistula. When the tract connects bowel to skin, 44640 is the more specific code.

How does 44650 differ from 44660 or 44661?

For an enterovesical fistula, use the specific bowel-to-bladder code: 44660 when repair is without intestinal or bladder resection, or 44661 when resection is performed.

What documentation supports 44650?

Document the fistula’s origin and destination, the bowel segments or adjacent structures involved, and the operative steps used to repair it. Include any resection performed.

Can modifier 50 be appended?

No. Modifier 50 is inappropriate for this intestinal fistula repair.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; 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
RVUs for 44650PPRRVU2026_Oct_nonQPP.csv, line 5,435 (RVU26D)

Open CMS sourceHow we calculate rates

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