No office rate
44640 is specific to a fistula connecting bowel and skin. Choose 44650 for other intestinal fistula anatomy when a more specific fistula code does not describe the repair.
On this page
CMS RVU26D · Effective 2026-10-01
44650 Fistula repair Medicare reimbursement rates in Kentucky
Reports operative repair of an intestinal fistula, with code selection guided by the fistula’s anatomy and the specific work documented in the operative report. Compare 44650 office and facility rates across CMS payment localities in Kentucky.
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 44650 in Kentucky?
Kentucky 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
No supported rate
Facility setting
$1272.03
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
Intestinal surgery
About 44650: Repair of Internal Intestinal Fistula
Reports operative repair of an intestinal fistula, with code selection guided by the fistula’s anatomy and the specific work documented in the operative report.
CPT 44650 describes operative repair of an abnormal tract involving intestine and another bowel segment or an adjacent structure. A general or colorectal surgeon typically performs the repair in a hospital operating room, identifying the tract and repairing the involved bowel opening or openings. The operative report should establish the fistula’s origin and destination and describe the repair performed.
Select the code based on the documented anatomy and procedure, not merely the diagnosis of a fistula. Use the more specific fistula codes when the connection is between bowel and skin or bowel and bladder. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. 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% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this service.
CMS billing rules for 44650
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU24.49 · 62%
- Practice expense (office) RVU9.63 · 24%
- Malpractice RVU5.50 · 14%
381
Medicare services in 2024 · #3777 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.
44650 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
44660 describes enterovesical fistula closure without intestinal or bladder resection; it is more specific than 44650 for that anatomy.
No office rate
44661 describes enterovesical fistula closure when intestinal and/or bladder resection is performed. The bowel-to-bladder connection and resection distinguish it from 44650.
Compare 44650 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$1272.03
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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 44650 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,435
- Code
- 44650
- Physician work
- 24.49
- Practice expense
- 9.63
- Malpractice
- 5.50
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 24.49 | × 1.000 | 24.4900 |
| Practice expense | 9.63 | × 0.889 | 8.5611 |
| Malpractice | 5.50 | × 0.915 | 5.0325 |
| Total RVUs | 38.0836 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1272.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 24.49 | 1 |
| Practice expense | 9.63 | 0.889 |
| Malpractice | 5.5 | 0.915 |
(24.49 × 1 + 9.63 × 0.889 + 5.5 × 0.915) × $33.4009 = $1272.03
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.
44650 billing questions
When should 44650 be chosen over 44640?
Use 44650 for an intestinal fistula that is not an enterocutaneous fistula. When the tract connects bowel to skin, 44640 is the more specific code.
How does 44650 differ from 44660 or 44661?
For an enterovesical fistula, use the specific bowel-to-bladder code: 44660 when repair is without intestinal or bladder resection, or 44661 when resection is performed.
What documentation supports 44650?
Document the fistula’s origin and destination, the bowel segments or adjacent structures involved, and the operative steps used to repair it. Include any resection performed.
Can modifier 50 be appended?
No. Modifier 50 is inappropriate for this intestinal fistula repair.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
5,43244625,,Repair bowel opening,A,,16.85,7.62,NA,7.62,,3.48,27.95,27.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43344626,,Repair bowel opening,A,,27.20,10.18,NA,10.18,,6.22,43.60,43.60,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43444640,,Repair bowel-skin fistula,A,,23.60,9.41,NA,9.41,,5.43,38.44,38.44,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43544650,,Repair bowel fistula,A,,24.49,9.63,NA,9.63,,5.50,39.62,39.62,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43644660,,Repair bowel-bladder fistula,A,,23.31,8.75,NA,8.75,,4.36,36.42,36.42,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43744661,,Repair bowel-bladder fistula,A,,26.67,9.85,NA,9.85,,5.82,42.34,42.34,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,43844680,,Surgical revision intestine,A,,17.51,8.02,NA,8.02,,4.69,30.22,30.22,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631