Billing code 44376: Small-bowel enteroscopyMedicare rate & RVUs in Illinois
Reports diagnostic small-intestinal enteroscopy extending beyond the second duodenal portion to include the ileum, with brushing or washing when performed.
CMS doesn’t publish an office rate for 44376 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 44376 covers
A gastroenterologist or other endoscopist advances an enteroscope through the upper gastrointestinal tract to examine small bowel beyond the second portion of the duodenum, including the ileum. The procedure can help evaluate suspected small-bowel sources of gastrointestinal bleeding or mucosal disease when the area is not accessible with routine upper endoscopy. Brushing or washing specimens may be collected as part of the diagnostic service.
Select this code when the documented examination includes the ileum and no separately described therapeutic maneuver determines a different code. The report should support the route and extent of examination, findings, and any brushing or washing performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. 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.
Where 44376 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 | $273.35 |
| East St. Louis | Unavailable | $261.77 |
| Rest Of Illinois | Unavailable | $253.19 |
| Suburban Chicago | Unavailable | $265.30 |
How the 44376 rate is calculated
Each of 44376’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 · 44376
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.02Practice expense 1.88Malpractice 0.54
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 44376
The CMS indicators that decide how 44376 is paid alongside other services.
CMS payment indicators · 44376
Small-bowel enteroscopy
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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
44376 without 51 · national facility
$248.50
Small-bowel enteroscopy
44376-51 · Second procedure: 50%
$124.25
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%).
44376 compared with similar codes
Compare codes
44376 vs 44360 vs 44361 vs 44377: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 44360Small-bowel exam
- Choose 44376 when the diagnostic enteroscopy includes the ileum; 44360 is the related diagnostic code for examination not including the ileum.
- 44361Small bowel endoscopy
- 44361 is the biopsy-specific code in the related small-intestinal endoscopy family. Use 44376 for diagnostic examination including the ileum without a separately coded biopsy maneuver.
- 44377Small bowel endoscopy
- 44377 describes enteroscopy including the ileum with biopsy. 44376 is the diagnostic service, including brushing or washing when performed, rather than the biopsy service.
44376 billing questions
How does this differ from 44360?
44376 describes diagnostic enteroscopy that includes the ileum. 44360 is the related diagnostic small-intestinal endoscopy code when the examination does not include the ileum.
Can brushing or washing be reported separately?
Brushing or washing specimen collection, when performed during this diagnostic enteroscopy, is included in the service.
Should I use 44376 when the endoscopist takes a biopsy?
Use the biopsy-specific code when tissue is sampled; 44377 is the related biopsy code for enteroscopy including the ileum. The procedure report should identify the biopsy.
What documentation supports 44376?
Document the enteroscopic route and extent, including examination of the ileum, the diagnostic findings, and any brushing or washing performed.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the others, which are paid at 50%.
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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