Billing code 44361: Small bowel endoscopyMedicare rate & RVUs in Illinois
Reports enteroscopy into the small bowel beyond the second portion of the duodenum, with tissue biopsy and without examination of the ileum.
CMS doesn’t publish an office rate for 44361 in Illinois.
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 44361 covers
A gastroenterologist or other qualified endoscopist advances an enteroscope beyond the second portion of the duodenum to examine the small bowel and obtain tissue samples. The examined segment may include the jejunum, but this code excludes examination of the ileum. Biopsies may be taken from abnormal-appearing mucosa or to investigate suspected small-bowel disease, such as a cause of malabsorption or unexplained anemia. These procedures are commonly performed in a hospital outpatient department or ambulatory endoscopy center.
Report 44361 when the endoscopist obtains one or more tissue biopsies during the qualifying examination; the number of samples does not create separate procedure units. The report should support the route and extent of the examination, the biopsy sites, and the reason for sampling. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted. Bilateral adjustment does not apply, and modifier 50 is inappropriate.
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.
Where 44361 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $154.00 |
| East St. Louis | Unavailable | $147.18 |
| Rest Of Illinois | Unavailable | $142.53 |
| Suburban Chicago | Unavailable | $149.83 |
How the 44361 rate is calculated
Each of 44361’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 · 44361
RVUs × geographic indexes × conversion factor
Work2.70
2.70 RVUs× 1.000 GPCI
Practice expense1.22
1.22 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
4.2100
Conversion factor
$33.4009
Medicare rate
$140.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44361
The CMS indicators that decide how 44361 is paid alongside other services.
CMS payment indicators · 44361
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) | 1 | Not paid (statutory restriction). |
| 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
44361 without 51 · national facility
$140.62
Small bowel endoscopy
44361-51 · Second procedure: 50%
$70.31
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%).
44361 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 44360Small-bowel exam
- 44360 describes the diagnostic examination without tissue biopsy. Choose 44361 when the endoscopist obtains biopsy tissue during the examination.
- 44377Small bowel endoscopy
- Both codes include small-bowel biopsy, but 44377 applies when the examination includes the ileum; 44361 excludes the ileum.
- 44364Small-bowel endoscopy
- 44364 describes snare removal of a lesion during small-bowel endoscopy. Report 44361 for biopsy sampling rather than snare excision.
- 44389Colonoscopy
- 44389 is a colonoscopy-through-stoma code with biopsy. It does not describe enteroscopy into the small bowel beyond the duodenum.
44361 billing questions
When should 44361 be reported instead of 44360?
Use 44361 when tissue biopsy is obtained during the qualifying small-bowel examination. Use 44360 for the diagnostic examination when no tissue biopsy is performed.
Does the code include multiple biopsy samples?
Yes. One or multiple biopsies during the examination are included in the procedure service; do not report a separate unit for each sample.
Can 44361 be used when the endoscopist examines the ileum?
No. This code describes examination beyond the second portion of the duodenum without including the ileum. For an examination that includes the ileum with biopsy, compare 44377.
How is 44361 handled when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The record should identify each examination and any distinct intervention or biopsy performed.
Is modifier 50 appropriate, and can an assistant or co-surgeon be paid?
No. Bilateral adjustment does not apply, and modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
What documentation supports reporting 44361?
Document the endoscopic route and extent, the small-bowel segment examined, the biopsy site or sites, and the clinical reason for obtaining tissue.
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
Show the CMS file lines behind this rate
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