$270.23
Both address endoscopic examination of a surgically created small-intestinal pouch. Choose 44386 when biopsy is performed; 44385 is for examination without biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
44386 Pouch endoscopy Medicare reimbursement rates in Hawaii
Reports endoscopic examination of a surgically created small-intestinal pouch when one or more tissue biopsies are obtained during the procedure. Compare 44386 office and facility rates across CMS payment localities in Hawaii.
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 44386 in Hawaii?
Hawaii 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
$385.30
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$82.25
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.
Gastrointestinal endoscopy
About 44386: Small intestinal pouch endoscopy with biopsy
Reports endoscopic examination of a surgically created small-intestinal pouch when one or more tissue biopsies are obtained during the procedure.
A gastroenterologist or colorectal surgeon uses an endoscope to examine a surgically created small-intestinal pouch, such as an ileal pouch or continent ileostomy reservoir, and takes tissue samples. The examination may assess symptoms or findings such as pouch inflammation, bleeding, or suspected Crohn disease. The route depends on the pouch anatomy: an ileal pouch may be reached through the anus, while a continent reservoir may be entered through its stoma.
Report this code when the pouch examination includes one or more biopsies; the number of samples does not create additional units. Document the pouch examined, the endoscopic findings, and biopsy sites or specimens. The procedure has a 0-day global period, so same-day preoperative and postoperative care are included. If multiple procedures are 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. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 44386
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.46 · 14%
- Practice expense (office) RVU8.77 · 84%
- Malpractice RVU0.18 · 2%
2.6K
Medicare services in 2024 · #2267 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.
44386 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$382.41
44388 describes colonoscopy through a stoma, rather than endoscopic examination of a small-intestinal pouch.
$499.37
44389 is colonoscopy through a stoma with biopsy. Use 44386 when the examined structure is a surgically created small-intestinal pouch.
Compare 44386 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
$385.30
Facility
$82.25
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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 44386 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,408
- Code
- 44386
- Physician work
- 1.46
- Practice expense
- 8.77
- Malpractice
- 0.18
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.46 | × 1.000 | 1.4600 |
| Practice expense | 8.77 | × 1.137 | 9.9715 |
| Malpractice | 0.18 | × 0.579 | 0.1042 |
| Total RVUs | 11.5357 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$385.30
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.46 | 1 |
| Practice expense | 8.77 | 1.137 |
| Malpractice | 0.18 | 0.579 |
(1.46 × 1 + 8.77 × 1.137 + 0.18 × 0.579) × $33.4009 = $385.30
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.46 | 1 |
| Practice expense | 0.79 | 1.137 |
| Malpractice | 0.18 | 0.579 |
(1.46 × 1 + 0.79 × 1.137 + 0.18 × 0.579) × $33.4009 = $82.25
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.
44386 billing questions
How does this differ from 44385?
Use 44386 when the pouch endoscopy includes biopsy. Code 44385 describes pouch endoscopy without biopsy.
Can multiple biopsy samples be reported as multiple units?
No. This code covers the pouch examination with one or more biopsies; multiple samples during the same procedure do not make multiple units.
Is biopsy included in the service?
Yes. The pouch examination and biopsy are represented together by this code. A separate pathology service may be reported by the provider who performs the tissue analysis.
Should modifier 50 be appended?
No. The pouch anatomy makes bilateral adjustment inappropriate, so modifier 50 is not appropriate for this service.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
How does the multiple-procedure reduction work?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% 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.
5,40544382,,Small bowel endoscopy,A,,1.14,8.75,,0.76,,0.13,10.02,2.03,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44380,33.4009,09,0,99,0.00,0.00,0.00
5,40644384,,Small bowel endoscopy,A,,2.78,0.90,NA,0.90,,0.36,4.04,4.04,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44380,33.4009,09,0,99,0.00,0.00,0.00
5,40744385,,Endoscopy of bowel pouch,A,,1.17,6.00,,0.68,,0.17,7.34,2.02,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,40844386,,Endoscopy bowel pouch/biop,A,,1.46,8.77,,0.79,,0.18,10.41,2.43,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,40944388,,Colonoscopy thru stoma spx,A,,2.65,7.53,,1.16,,0.41,10.59,4.22,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,41044388,53,Colonoscopy thru stoma spx,A,,1.33,3.76,,0.58,,0.21,5.30,2.12,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,41144389,,Colonoscopy with biopsy,A,,2.94,10.36,,1.26,,0.40,13.70,4.60,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
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