No office rate
Choose 44660 for fistula closure without intestinal resection. Consider 44661 when the operative service includes resection of intestine.
On this page
CMS RVU26D · Effective 2026-10-01
44660 Bowel-bladder fistula repair Medicare reimbursement rates
Reports operative closure of an abnormal connection between intestine and bladder when the repair is performed without intestinal resection. Compare 44660 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 44660?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 44660 pays more and less
Intestinal surgery
About 44660: Enterovesical fistula repair without bowel resection
Reports operative closure of an abnormal connection between intestine and bladder when the repair is performed without intestinal resection.
This service treats an abnormal passage between the bowel and urinary bladder, often a colovesical fistula associated with diverticular disease. A colorectal or general surgeon typically operates in a hospital or other surgical facility, separating the involved organs and closing the fistula. A urologist may participate when the bladder portion requires additional operative attention. The code distinguishes repair without bowel resection from the related service that includes intestinal resection.
Report the code when the operative record supports closure of the bowel-bladder tract without resecting intestine; document the fistula’s location, operative steps, and whether bowel was removed. This is major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Bilateral adjustment does not apply because modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 44660
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU23.31 · 64%
- Practice expense (office) RVU8.75 · 24%
- Malpractice RVU4.36 · 12%
186
Medicare services in 2024 · #4381 by national volume
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.
44660 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
This code addresses a bowel-bladder connection. Code 44650 is for a different intestinal fistula repair, so the documented destination of the tract matters.
No office rate
44640 concerns a bowel-to-skin fistula; 44660 is for a connection between bowel and bladder.
No office rate
44604 describes suturing large intestine, not repair of a bowel-bladder fistula. Select based on the operation actually performed.
See how rates vary across the country
44660 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 44660 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1116.73 |
| Alaska* | Office Unavailable | Facility $1559.36 |
| Arizona | Office Unavailable | Facility $1186.43 |
| Arkansas | Office Unavailable | Facility $1104.62 |
| Atlanta | Office Unavailable | Facility $1252.74 |
| Austin | Office Unavailable | Facility $1218.37 |
| Bakersfield | Office Unavailable | Facility $1202.37 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1284.77 |
| Beaumont | Office Unavailable | Facility $1179.82 |
| Brazoria | Office Unavailable | Facility $1188.02 |
| Chicago | Office Unavailable | Facility $1411.96 |
| Chico | Office Unavailable | Facility $1190.18 |
| Colorado | Office Unavailable | Facility $1212.62 |
| Connecticut | Office Unavailable | Facility $1285.12 |
| Dallas | Office Unavailable | Facility $1201.62 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1326.98 |
| Delaware | Office Unavailable | Facility $1202.14 |
| Detroit | Office Unavailable | Facility $1306.13 |
| East St. Louis | Office Unavailable | Facility $1340.75 |
| El Centro | Office Unavailable | Facility $1190.91 |
| Fort Lauderdale | Office Unavailable | Facility $1337.93 |
| Fort Worth | Office Unavailable | Facility $1200.59 |
| Fresno | Office Unavailable | Facility $1190.18 |
| Galveston | Office Unavailable | Facility $1195.60 |
| Hanford-Corcoran | Office Unavailable | Facility $1190.18 |
| Hawaii, Guam | Office Unavailable | Facility $1195.19 |
| Houston | Office Unavailable | Facility $1275.40 |
| Idaho | Office Unavailable | Facility $1116.33 |
| Indiana | Office Unavailable | Facility $1120.27 |
| Iowa | Office Unavailable | Facility $1103.81 |
| Kansas | Office Unavailable | Facility $1116.17 |
| Kentucky | Office Unavailable | Facility $1171.64 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1252.93 |
| Madera | Office Unavailable | Facility $1190.18 |
| Manhattan | Office Unavailable | Facility $1398.97 |
| Merced | Office Unavailable | Facility $1190.18 |
| Metropolitan Boston | Office Unavailable | Facility $1289.06 |
| Metropolitan Kansas City | Office Unavailable | Facility $1195.28 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1270.56 |
| Metropolitan St. Louis | Office Unavailable | Facility $1202.72 |
| Miami | Office Unavailable | Facility $1451.11 |
| Minnesota | Office Unavailable | Facility $1122.41 |
| Mississippi | Office Unavailable | Facility $1137.83 |
| Modesto | Office Unavailable | Facility $1190.18 |
| Montana** | Office Unavailable | Facility $1216.17 |
| Napa | Office Unavailable | Facility $1286.80 |
| Nebraska | Office Unavailable | Facility $1103.38 |
| Nevada** | Office Unavailable | Facility $1192.43 |
| New Hampshire | Office Unavailable | Facility $1210.24 |
| New Mexico | Office Unavailable | Facility $1221.47 |
| New Orleans | Office Unavailable | Facility $1219.02 |
| North Carolina | Office Unavailable | Facility $1144.31 |
| North Dakota** | Office Unavailable | Facility $1129.96 |
| Northern Nj | Office Unavailable | Facility $1322.17 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1446.33 |
| Ohio | Office Unavailable | Facility $1192.20 |
| Oklahoma | Office Unavailable | Facility $1152.71 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1236.55 |
| Portland | Office Unavailable | Facility $1224.08 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1309.84 |
| Puerto Rico | Office Unavailable | Facility $1217.49 |
| Queens | Office Unavailable | Facility $1383.85 |
| Redding | Office Unavailable | Facility $1190.18 |
| Rest Of California | Office Unavailable | Facility $1190.18 |
| Rest Of Florida | Office Unavailable | Facility $1276.85 |
| Rest Of Georgia | Office Unavailable | Facility $1212.86 |
| Rest Of Illinois | Office Unavailable | Facility $1273.02 |
| Rest Of Louisiana | Office Unavailable | Facility $1176.73 |
| Rest Of Maine | Office Unavailable | Facility $1138.03 |
| Rest Of Maryland | Office Unavailable | Facility $1215.81 |
| Rest Of Massachusetts | Office Unavailable | Facility $1214.85 |
| Rest Of Michigan | Office Unavailable | Facility $1209.82 |
| Rest Of Missouri | Office Unavailable | Facility $1172.34 |
| Rest Of New Jersey | Office Unavailable | Facility $1288.62 |
| Rest Of New York | Office Unavailable | Facility $1158.60 |
| Rest Of Oregon | Office Unavailable | Facility $1172.04 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1184.49 |
| Rest Of Texas | Office Unavailable | Facility $1187.43 |
| Rest Of Washington | Office Unavailable | Facility $1207.27 |
| Rhode Island | Office Unavailable | Facility $1225.17 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1237.12 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1224.56 |
| Salinas | Office Unavailable | Facility $1219.49 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1230.40 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1331.47 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1326.52 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1363.71 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1343.47 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1202.75 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1228.07 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1219.20 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1238.88 |
| Seattle (King Cnty) | Office Unavailable | Facility $1295.08 |
| South Carolina | Office Unavailable | Facility $1172.40 |
| South Dakota** | Office Unavailable | Facility $1119.76 |
| Southern Maine | Office Unavailable | Facility $1160.09 |
| Stockton | Office Unavailable | Facility $1190.18 |
| Suburban Chicago | Office Unavailable | Facility $1342.23 |
| Tennessee | Office Unavailable | Facility $1122.44 |
| Utah | Office Unavailable | Facility $1184.07 |
| Vallejo | Office Unavailable | Facility $1279.66 |
| Vermont | Office Unavailable | Facility $1141.60 |
| Virgin Islands | Office Unavailable | Facility $1217.49 |
| Virginia | Office Unavailable | Facility $1168.68 |
| Visalia | Office Unavailable | Facility $1190.18 |
| West Virginia | Office Unavailable | Facility $1240.94 |
| Wisconsin | Office Unavailable | Facility $1103.41 |
| Wyoming** | Office Unavailable | Facility $1178.60 |
| Yuba City | Office Unavailable | Facility $1190.18 |
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44660 billing questions
When should 44660 be selected instead of 44661?
Use 44660 when the fistula is repaired without intestinal resection. If the operation includes resection of intestine, compare the documentation with 44661.
Can modifier 50 be reported for a fistula involving both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is 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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,43344626,,Repair bowel opening,A,,27.20,10.18,NA,10.18,,6.22,43.60,43.60,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43444640,,Repair bowel-skin fistula,A,,23.60,9.41,NA,9.41,,5.43,38.44,38.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43544650,,Repair bowel fistula,A,,24.49,9.63,NA,9.63,,5.50,39.62,39.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43644660,,Repair bowel-bladder fistula,A,,23.31,8.75,NA,8.75,,4.36,36.42,36.42,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43744661,,Repair bowel-bladder fistula,A,,26.67,9.85,NA,9.85,,5.82,42.34,42.34,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43844680,,Surgical revision intestine,A,,17.51,8.02,NA,8.02,,4.69,30.22,30.22,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43944700,,Suspend bowel w/prosthesis,A,,17.04,7.30,NA,7.30,,3.10,27.44,27.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00