Billing code 44188: ColostomyMedicare rate & RVUs in Washington
Report laparoscopic creation of a colonic stoma to divert intestinal contents, such as for obstruction, perforation, or protection of distal bowel.
CMS doesn’t publish an office rate for 44188 in Washington.
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 44188 covers
The surgeon uses laparoscopic access to bring a portion of the colon to the abdominal wall and form a stoma. Colorectal and general surgeons commonly perform this operation in a hospital operating room to divert stool around distal obstruction, injury, inflammation, or a healing colorectal repair. The stoma may be intended as temporary diversion or long-term fecal diversion; the code identifies colonic rather than small-bowel ostomy creation.
Select 44188 when laparoscopic colostomy creation is the service performed, rather than a more extensive bowel-resection procedure that includes ostomy construction. The operative report should identify the laparoscopic approach, the colonic stoma created, and the clinical reason for diversion. Related preoperative care on the day before surgery and 90 days of postoperative care are included in the 90-day global period. When other procedures are performed in the same 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 may be available; co-surgeon payment requires supporting documentation, and team surgery 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 44188 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,133.77 |
| Seattle (King Cnty) | Unavailable | $1,229.12 |
How the 44188 rate is calculated
Each of 44188’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 · 44188
RVUs × geographic indexes × conversion factor
Work18.87
18.87 RVUs× 1.000 GPCI
Practice expense11.04
11.04 RVUs× 1.000 GPCI
Malpractice4.21
4.21 RVUs× 1.000 GPCI
Adjusted RVUs
34.1200
Conversion factor
$33.4009
Medicare rate
$1,139.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 44188
44188 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44188
Colostomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 44188
Colostomy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
44188 without 51 · national facility
$1,139.64
Colostomy
44188-51 · Second procedure: 50%
$569.82
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%).
44188 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 44187Laparoscopic ostomy
- Use 44187 for laparoscopic ileostomy or jejunostomy creation; 44188 creates a colonic stoma.
- 44320Colostomy
- 44320 describes open colostomy creation. Choose 44188 when the stoma is created laparoscopically.
- 44206Partial colectomy
- 44206 includes laparoscopic partial colectomy with end colostomy. It is the more appropriate service when that bowel resection and diversion are performed together.
44188 billing questions
How does 44188 differ from a laparoscopic ileostomy?
44188 is for creating a colonic stoma. Use 44187 for laparoscopic ileostomy or jejunostomy creation.
Can 44188 be reported separately with a colectomy?
When a colectomy code describes the resection and associated ostomy construction, report that comprehensive procedure rather than separately reporting 44188 for the stoma.
What is the difference between 44188 and 44320?
Both describe colostomy creation, but 44188 is laparoscopic and 44320 is the open approach.
What documentation supports 44188?
The operative report should establish laparoscopic access, creation of a colonic stoma, and the indication for diversion. It should also make clear whether bowel resection was part of the operation.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be available for 44188. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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