Billing code 44381: IleoscopyMedicare rate & RVUs in Illinois
Reports ileal examination through an existing stoma when the endoscopist obtains one or more tissue samples for diagnostic evaluation.
Medicare pays $982.23–$1,099.64 for 44381 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. Which amount applies depends on the service address.
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 44381 covers
A flexible endoscope is passed through an existing ileostomy or other small-bowel stoma to examine the ileum and obtain one or more mucosal biopsies. Gastroenterologists and surgeons commonly perform this procedure in a hospital outpatient department or ambulatory surgery center. Biopsies may support evaluation of suspected inflammation, unexplained symptoms, or a known small-bowel condition; the report should identify the route, examined anatomy, and biopsy performed.
Choose this code when the examination is through a stoma and tissue is sampled, rather than reporting the diagnostic stoma ileoscopy code alone. Document the indication, findings, and biopsy site or sites. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Do not use modifier 50; CMS identifies bilateral adjustment as inappropriate for this anatomy and service. CMS payment is restricted for an assistant at surgery, and co-surgeon and team-surgery payment is 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 44381 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.
4 payment localities
$982.23 to $1099.64
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $1,080.25 | $85.29 |
| East St. Louis | $991.91 | $81.11 |
| Rest Of Illinois | $982.23 | $78.36 |
| Suburban Chicago | $1,099.64 | $82.91 |
How the 44381 rate is calculated
Each of 44381’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 · 44381
RVUs × geographic indexes × conversion factor
Work1.35
1.35 RVUs× 1.000 GPCI
Practice expense30.44
30.44 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
31.9600
Conversion factor
$33.4009
Medicare rate
$1,067.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44381
The CMS indicators that decide how 44381 is paid alongside other services.
CMS payment indicators · 44381
Ileoscopy
| 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
44381 without 51 · national office
$1,067.49
Ileoscopy
44381-51 · Second procedure: 50%
$533.75
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%).
44381 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44380Ileoscopy
- Both describe ileoscopy through a stoma. Report 44381 when tissue is biopsied; 44380 is the diagnostic examination without biopsy.
- 44361Small bowel endoscopy
- Both involve small-bowel endoscopy with biopsy, but 44381 is specifically performed through a stoma; 44361 describes enteroscopy beyond the second portion of the duodenum.
- 44385Pouch endoscopy
- 44385 examines an ileal pouch. Use 44381 for ileal examination through a stoma with biopsy, not examination of a pouch.
44381 billing questions
How does this differ from 44380?
44381 is for ileoscopy through a stoma when one or more biopsies are obtained. Use 44380 for the diagnostic stoma examination without biopsy.
Can the biopsy be billed separately?
The biopsy is part of the service represented by 44381; do not report a separate biopsy procedure for the sampling included in this endoscopy.
Is modifier 50 appropriate for an examination of both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code and anatomy.
What happens when another related endoscopy is performed in the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Document each procedure and its distinct work.
What documentation supports reporting 44381?
Document that the endoscope passed through a stoma, the ileal examination and findings, and that tissue was obtained, including the biopsy site or sites when known.
Can an assistant surgeon or co-surgeon be paid for this service?
CMS restricts payment for an assistant at surgery and does not permit co-surgeon or team-surgery payment for this code.
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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