$321.10
Both examine an ileal pouch. Choose 44385 when no tissue biopsy is taken; choose 44386 when one or more tissue biopsies are performed.
On this page
CMS RVU26D · Effective 2026-10-01
44385 Pouch endoscopy Medicare reimbursement rates in Idaho
Endoscopic inspection of an ileal pouch is reported for evaluation when the examination does not include tissue biopsy. Compare 44385 office and facility rates across CMS payment localities in Idaho.
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 44385 in Idaho?
Idaho 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
$226.14
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$62.66
1 of 1 localities have a supported rate.
Payment area: Idaho
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 44385: Diagnostic ileal pouch endoscopy
Endoscopic inspection of an ileal pouch is reported for evaluation when the examination does not include tissue biopsy.
This service examines an ileal reservoir with an endoscope, such as a pouch created after restorative proctocolectomy. Gastroenterologists and colorectal surgeons commonly perform it to evaluate symptoms such as pouch-related inflammation, bleeding, or altered bowel function. The examination may include collecting cells or fluid by brushing or washing; those methods do not make it a biopsy service.
Report this code when the pouch is examined without tissue sampling. If the endoscopist takes tissue biopsies, use the related biopsy code instead. The report should identify the pouch examined, the examination findings, and any specimen collection method. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 44385
- 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 RVU1.17 · 16%
- Practice expense (office) RVU6.00 · 82%
- Malpractice RVU0.17 · 2%
1.1K
Medicare services in 2024 · #2901 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.
44385 compared with similar codes
Office rates for Idaho, from the same CMS release.
$326.38
44385 examines an ileal pouch. 44388 applies when the endoscope is used for colonoscopy through a stoma.
$422.87
44389 is for colonoscopy through a stoma with biopsy. For biopsy of an ileal pouch, use 44386 instead.
Compare 44385 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
Idaho →
Office / nonfacility
$226.14
Facility
$62.66
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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 44385 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
5,407
- Code
- 44385
- Physician work
- 1.17
- Practice expense
- 6.00
- Malpractice
- 0.17
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.17 | × 1.000 | 1.1700 |
| Practice expense | 6.00 | × 0.920 | 5.5200 |
| Malpractice | 0.17 | × 0.473 | 0.0804 |
| Total RVUs | 6.7704 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$226.14
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.17 | 1 |
| Practice expense | 6 | 0.92 |
| Malpractice | 0.17 | 0.473 |
(1.17 × 1 + 6 × 0.92 + 0.17 × 0.473) × $33.4009 = $226.14
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.17 | 1 |
| Practice expense | 0.68 | 0.92 |
| Malpractice | 0.17 | 0.473 |
(1.17 × 1 + 0.68 × 0.92 + 0.17 × 0.473) × $33.4009 = $62.66
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.
44385 billing questions
When should 44385 be used instead of 44386?
Use 44385 for pouch examination without tissue biopsy, including when brushing or washing is performed. Use 44386 when tissue is sampled by biopsy.
Are brushing and washing included in 44385?
Yes. Specimen collection by brushing or washing, when performed during the pouch examination, is included in this service.
Is modifier 50 appropriate for pouch endoscopy?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the multiple-procedure reduction affect 44385?
When it is performed in the same session as other procedures, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
What care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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.
5,40444381,,Small bowel endoscopy br/wa,A,,1.35,30.44,,0.80,,0.17,31.96,2.32,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44380,33.4009,09,0,99,0.00,0.00,0.00
5,40544382,,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
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772