Billing code 44363: Small bowel endoscopyMedicare rate & RVUs in Delaware
Reports deep small-bowel enteroscopy when the endoscopist removes a polyp, tumor, or other lesion using a snare during the procedure.
CMS doesn’t publish an office rate for 44363 in Delaware.
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 44363 covers
A gastroenterologist or other qualified endoscopist advances an enteroscope beyond the second portion of the duodenum to examine the small bowel and remove a lesion with a snare. The service is commonly performed in a hospital or ambulatory endoscopy setting when a small-bowel lesion has been identified or is encountered during enteroscopy. The report should identify the extent of examination, the lesion treated, and the snare technique used.
Choose this code for snare removal, not for diagnostic examination alone, tissue sampling, or removal by another method. Document the target and treatment performed; the record should support that the instrument reached the small bowel beyond the second duodenal portion. CMS applies endoscopy-family pricing when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documentation of 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.
44363 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $168.39 |
How the 44363 rate is calculated
Each of 44363’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 · 44363
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.31Practice expense 1.39Malpractice 0.38
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 44363
The CMS indicators that decide how 44363 is paid alongside other services.
CMS payment indicators · 44363
Small bowel endoscopy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44363 without 51 · national facility
$169.68
Small bowel endoscopy
44363-51 · Second procedure: 50%
$84.84
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%).
44363 compared with similar codes
Compare codes
44363 vs 44361 vs 44364 vs 44366: national Medicare rates
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How to choose
- 44361Small bowel endoscopy
- Report 44361 for biopsy sampling during small-bowel enteroscopy. Report 44363 when a lesion is removed using a snare.
- 44364Small-bowel endoscopy
- 44364 represents lesion removal by hot biopsy forceps or bipolar cautery; 44363 is distinguished by snare removal.
- 44366Enteroscopy hemostasis
- 44366 is for lesion ablation rather than snare excision. Select according to the endoscopic treatment actually performed.
44363 billing questions
How does this differ from 44361?
44363 is for snare removal of a lesion. 44361 describes small-bowel endoscopy with biopsy, so use it when tissue is sampled rather than removed by snare.
When should 44364 be considered instead?
Use 44364 when the lesion is removed with hot biopsy forceps or bipolar cautery rather than a snare. The documented removal method distinguishes these codes.
Can diagnostic enteroscopy be reported separately with 44363?
The examination is part of the therapeutic enteroscopy. When related endoscopies are performed together, CMS endoscopy-family pricing applies.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
What does the 0-day global period include?
Same-day preoperative and postoperative care is included. The global period is limited to the procedure date.
What documentation supports assistant-at-surgery payment?
The record must document medical necessity for the assistant. CMS does not permit co-surgeons or team surgery for this service.
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
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