Billing code 44186: JejunostomyMedicare rate & RVUs in Alaska
Reports laparoscopic placement of a jejunostomy feeding tube when enteral nutrition must bypass the stomach or oral intake is inadequate.
CMS doesn’t publish an office rate for 44186 in Alaska.
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 9 sections
What 44186 covers
A surgeon uses laparoscopic access to create an opening into the jejunum and place a feeding tube for enteral nutrition. The procedure is used when a patient needs nutrition delivered to the small intestine, such as when gastric feeding is not suitable. It is generally performed in an operating room, commonly during a facility-based surgical admission.
Report this code when the operative record supports laparoscopic jejunostomy tube placement; distinguish it from a laparoscopic non-tube ileostomy or jejunostomy. Documentation should identify the approach, jejunal site, tube placement, and clinical reason for feeding access. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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.
44186 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $768.12 |
How the 44186 rate is calculated
Each of 44186’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 · 44186
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.12Practice expense 6.00Malpractice 2.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 44186
44186 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44186
Jejunostomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.84/0.07 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 44186
Jejunostomy
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44186 without 51 · national facility
$624.93
Jejunostomy
44186-51 · Second procedure: 50%
$312.47
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%).
44186 compared with similar codes
Compare codes
44186 vs 44187 vs 44300 vs 49440: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 44187Laparoscopic ostomy
- Choose 44186 for laparoscopic jejunostomy with a feeding tube. Choose 44187 for a laparoscopic ileostomy or jejunostomy without a tube.
- 44300Enterostomy tube
- 44300 represents enterostomy tube placement by a different operative approach. 44186 specifically represents laparoscopic placement of a feeding jejunostomy.
- 49440Gastrostomy placement
- 49440 is percutaneous gastrostomy tube placement, not laparoscopic access to the jejunum. The procedure performed and the feeding site distinguish the codes.
44186 billing questions
How does this differ from 44187?
44186 is for laparoscopic jejunostomy with feeding-tube placement. 44187 describes a laparoscopic ileostomy or jejunostomy without a tube.
Can the tube placement and jejunostomy opening be billed separately?
The laparoscopic feeding jejunostomy is the service represented by 44186. Do not separately report the access creation as another procedure when it is part of that same operative service.
What documentation supports 44186?
The operative report should establish the laparoscopic approach, the jejunal site, placement of a feeding tube, and the clinical need for jejunal feeding.
How is postoperative care handled?
The code has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment for this code.
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
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