No office rate
Choose 44405 for dilation of a narrowed segment; choose 44402 when the colonoscopy includes stent placement.
On this page
CMS RVU26D · Effective 2026-10-01
44405 Colonoscopy Medicare reimbursement rates in Vermont
Reports colonoscopy during which a narrowed colonic segment is therapeutically dilated, typically with a balloon passed through the endoscope. Compare 44405 office and facility rates across CMS payment localities in Vermont.
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 44405 in Vermont?
Vermont 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
$603.66
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$156.27
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Gastroenterology
About 44405: Colonoscopy with balloon dilation
Reports colonoscopy during which a narrowed colonic segment is therapeutically dilated, typically with a balloon passed through the endoscope.
A flexible colonoscope is advanced to a narrowed area of the colon, and a dilation device is used through the scope to widen the stenosis. Gastroenterologists and colorectal surgeons commonly perform this treatment for symptomatic narrowing, including a stricture at a surgical anastomosis, in a hospital outpatient department or ambulatory surgery center. The service is therapeutic rather than a routine colonoscopy alone.
Select this code when dilation is performed during the colonoscopy. Document the indication, stricture location and findings, dilation method, and procedural result. 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 governs payment rather than independent pricing for each procedure. An assistant at surgery is not paid under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 44405
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- 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 RVU3.15 · 17%
- Practice expense (office) RVU14.89 · 81%
- Malpractice RVU0.36 · 2%
44
Medicare services in 2024 · #5434 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.
44405 compared with similar codes
Office rates for Vermont, from the same CMS release.
Compare 44405 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
Vermont →
Office / nonfacility
$603.66
Facility
$156.27
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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 44405 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,420
- Code
- 44405
- Physician work
- 3.15
- Practice expense
- 14.89
- Malpractice
- 0.36
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.15 | × 1.000 | 3.1500 |
| Practice expense | 14.89 | × 0.990 | 14.7411 |
| Malpractice | 0.36 | × 0.506 | 0.1822 |
| Total RVUs | 18.0733 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$603.66
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.15 | 1 |
| Practice expense | 14.89 | 0.99 |
| Malpractice | 0.36 | 0.506 |
(3.15 × 1 + 14.89 × 0.99 + 0.36 × 0.506) × $33.4009 = $603.66
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.15 | 1 |
| Practice expense | 1.36 | 0.99 |
| Malpractice | 0.36 | 0.506 |
(3.15 × 1 + 1.36 × 0.99 + 0.36 × 0.506) × $33.4009 = $156.27
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.
44405 billing questions
When should this code be chosen instead of a colonoscopy with stent placement?
Use this code when the colonoscopic treatment is dilation of a narrowing. A procedure that places a stent is represented by the stent-placement service instead.
What documentation supports reporting dilation?
Record the reason for treatment, the narrowed segment and its findings, the dilation technique, and the result. The record should show that dilation was actually performed.
How are related endoscopies priced when performed together?
CMS applies endoscopy-family pricing to related endoscopies performed together, rather than treating each as independently priced.
Is same-day postoperative care included?
Yes. This code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant, co-surgeon, or surgical team be billed?
An assistant at surgery is not paid under the statutory restriction. Co-surgeons and team surgery are not permitted for this service.
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.
5,41744402,,Colonoscopy w/stent plcmt,A,,4.58,1.78,NA,1.78,,0.50,6.86,6.86,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,41844403,,Colonoscopy w/resection,A,,5.36,2.01,NA,2.01,,0.59,7.96,7.96,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,41944404,,Colonoscopy w/injection,A,,2.94,10.61,,1.25,,0.39,13.94,4.58,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,42044405,,Colonoscopy w/dilation,A,,3.15,14.89,,1.36,,0.36,18.40,4.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,42144406,,Colonoscopy w/ultrasound,A,,4.00,1.61,NA,1.61,,0.44,6.05,6.05,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,42244407,,Colonoscopy w/ndl aspir/bx,A,,4.84,1.85,NA,1.85,,0.53,7.22,7.22,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
5,42344408,,Colonoscopy w/decompression,A,,4.04,1.62,NA,1.62,,0.44,6.10,6.10,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44388,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817