No office rate
Use 44640 for a bowel-to-skin fistula; 44650 is for an enterocolic fistula connecting bowel segments.
On this page
CMS RVU26D · Effective 2026-10-01
44640 Fistula repair Medicare reimbursement rates in Colorado
Reports surgical closure of a communication between bowel and skin, such as a persistent enteric-draining opening in the abdominal wall. Compare 44640 office and facility rates across CMS payment localities in Colorado.
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 44640 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1273.79
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Intestinal surgery
About 44640: Enterocutaneous fistula repair
Reports surgical closure of a communication between bowel and skin, such as a persistent enteric-draining opening in the abdominal wall.
This code applies when a surgeon repairs an enterocutaneous fistula, an abnormal connection that lets bowel contents reach the skin. A typical presentation is persistent intestinal drainage through an abdominal wound or skin opening, often after prior abdominal surgery. General or colorectal surgeons usually perform the repair in an operating room, identifying the bowel-to-skin tract and closing the communication.
Select this code for a bowel-to-skin fistula, rather than a planned opening created as an enterostomy or a fistula involving another organ. The operative report should identify the fistula’s bowel and skin connection and describe the repair performed. The 90-day global period includes 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 the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 44640
- 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 RVU23.60 · 61%
- Practice expense (office) RVU9.41 · 24%
- Malpractice RVU5.43 · 14%
804
Medicare services in 2024 · #3145 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.
44640 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Use 44660 for an enterovesical fistula involving the bladder when the repair is without intestinal or bladder resection.
No office rate
Use 44661 for an enterovesical fistula repair involving intestinal or bladder resection, rather than a bowel-to-skin fistula.
No office rate
Use 44620 to close a surgically created enterostomy; 44640 repairs an abnormal bowel-to-skin fistula.
Compare 44640 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$1273.79
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 44640 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,434
- Code
- 44640
- Physician work
- 23.60
- Practice expense
- 9.41
- Malpractice
- 5.43
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.60 | × 1.012 | 23.8832 |
| Practice expense | 9.41 | × 1.064 | 10.0122 |
| Malpractice | 5.43 | × 0.781 | 4.2408 |
| Total RVUs | 38.1363 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$1273.79
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.6 | 1.012 |
| Practice expense | 9.41 | 1.064 |
| Malpractice | 5.43 | 0.781 |
(23.6 × 1.012 + 9.41 × 1.064 + 5.43 × 0.781) × $33.4009 = $1273.79
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
44640 billing questions
When is 44640 appropriate?
Use it for surgical repair of a fistula connecting bowel to the skin, such as an enteric-draining abdominal wound. The operative documentation should establish that bowel-to-skin communication.
How is this different from closing an enterostomy?
An enterostomy is a surgically created bowel opening, while 44640 addresses an abnormal bowel-to-skin fistula. Consider 44620 for enterostomy closure.
What care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard 50% multiple-procedure reduction.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and 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 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.
5,43144620,,Repair bowel opening,A,,14.07,6.96,NA,6.96,,3.04,24.07,24.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43244625,,Repair bowel opening,A,,16.85,7.62,NA,7.62,,3.48,27.95,27.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43344626,,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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899