No office rate
44120 reports the primary small-intestine resection with anastomosis. Use 44121 only for an additional resection and anastomosis in the same operative session.
On this page
CMS RVU26D · Effective 2026-10-01
44121 Small bowel resection Medicare reimbursement rates in Guam
Reports an additional small-intestine segment resection with anastomosis performed during an operative session that includes the primary resection. Compare 44121 office and facility rates across CMS payment localities in Guam.
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 44121 in Guam?
Guam 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
$206.33
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Small intestine surgery
About 44121: Additional small bowel resection with anastomosis
Reports an additional small-intestine segment resection with anastomosis performed during an operative session that includes the primary resection.
This add-on describes another small-intestine segment resection with an anastomosis during the same operative session as the primary resection. A surgeon may perform it when separate diseased segments require individual removal and reconnection, such as in a patient with more than one affected area of bowel. It distinguishes an additional resection and anastomosis from simply removing a longer continuous segment.
Report 44121 with the applicable primary procedure, not by itself. The operative report should establish that an additional segment was resected and anastomosed, beyond the resection represented by the primary code. CMS treats this as an add-on code: payment is handled within the primary procedure’s global period. The primary procedure and the additional work should be identifiable in the operative documentation.
CMS billing rules for 44121
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU4.33 · 67%
- Practice expense (office) RVU1.08 · 17%
- Malpractice RVU1.07 · 17%
1.7K
Medicare services in 2024 · #2566 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.
44121 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
44125 describes a small-intestine resection with enterostomy. 44121 is for additional resection work with anastomosis.
No office rate
44203 is the laparoscopic add-on for additional small-intestine resection and anastomosis; 44121 is the corresponding add-on for the open procedure.
Compare 44121 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$206.33
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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 44121 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,336
- Code
- 44121
- Physician work
- 4.33
- Practice expense
- 1.08
- Malpractice
- 1.07
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.33 | × 1.000 | 4.3300 |
| Practice expense | 1.08 | × 1.137 | 1.2280 |
| Malpractice | 1.07 | × 0.579 | 0.6195 |
| Total RVUs | 6.1775 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$206.33
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.33 | 1 |
| Practice expense | 1.08 | 1.137 |
| Malpractice | 1.07 | 0.579 |
(4.33 × 1 + 1.08 × 1.137 + 1.07 × 0.579) × $33.4009 = $206.33
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.
44121 billing questions
When is 44121 reported with 44120?
Use 44121 for an additional small-intestine resection and anastomosis beyond the primary resection reported with 44120. The additional work must be documented in the operative report.
Can 44121 be billed by itself?
No. It is an add-on code and must be reported with an applicable primary procedure.
Does a longer single resection support 44121?
Not by itself. The documentation should show another resection and anastomosis, rather than only a longer continuous segment removed as part of the primary resection.
How does 44121 differ from 44125?
44121 represents an additional resection with anastomosis. 44125 describes a small-intestine resection with an enterostomy, a different reconstruction.
How is 44121 paid in relation to the primary procedure?
CMS identifies it as an add-on code paid within the primary procedure’s global period. It cannot be reported without the primary procedure.
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.
5,33344110,,Excise intestine lesion(s),A,,13.69,7.00,NA,7.00,,3.18,23.87,23.87,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33444111,,Excision of bowel lesion(s),A,,16.11,7.57,NA,7.57,,3.43,27.11,27.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33544120,,Removal of small intestine,A,,20.30,8.62,NA,8.62,,5.10,34.02,34.02,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33644121,,Removal of small intestine,A,,4.33,1.08,NA,1.08,,1.07,6.48,6.48,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33744125,,Removal of small intestine,A,,19.53,8.63,NA,8.63,,4.70,32.86,32.86,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33844126,,Enterectomy w/o taper cong,A,,41.17,16.20,NA,16.20,,11.05,68.42,68.42,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,33944127,,Enterectomy w/taper cong,A,,48.07,17.73,NA,17.73,,12.87,78.67,78.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014