Billing code 44227: Enterostomy closureMedicare rate & RVUs in Washington
Reports laparoscopic reversal of a small- or large-bowel enterostomy when the stoma-bearing segment is resected and intestinal continuity is restored.
CMS doesn’t publish an office rate for 44227 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 44227 covers
The surgeon closes an enterostomy using a laparoscopic approach, removes the stoma-bearing bowel segment, and restores intestinal continuity with an anastomosis. This commonly occurs when a temporary ileostomy or colostomy is reversed after the original bowel condition has healed. General or colorectal surgeons typically perform the operation in a hospital operating room; specimen extraction may require an incision.
Report this code when the operative record supports laparoscopic closure with bowel resection and anastomosis. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple 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. Modifier 50 is inappropriate for this procedure. Assistant-at-surgery payment may be made; 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 44227 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,502.19 |
| Seattle (King Cnty) | Unavailable | $1,614.46 |
How the 44227 rate is calculated
Each of 44227’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 · 44227
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 27.90Practice expense 11.39Malpractice 6.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 44227
44227 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 44227
Enterostomy closure
| 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 · 44227
Enterostomy closure
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
44227 without 51 · national facility
$1,519.41
Enterostomy closure
44227-51 · Second procedure: 50%
$759.71
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%).
44227 compared with similar codes
Compare codes
44227 vs 44620 vs 44625 vs 44626 vs 44206: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 44620Stoma closure
- This open closure code applies when the enterostomy is closed without bowel resection; 44227 describes laparoscopic closure with resection and anastomosis.
- 44625Ostomy reversal
- This is the open closure counterpart for resection and anastomosis when the enterostomy is other than colorectal. Use 44227 for the laparoscopic approach.
- 44626Enterostomy closure
- This is the open closure counterpart for colorectal or Hartmann-type reversal with resection and anastomosis. Use 44227 when that closure is laparoscopic.
- 44206Partial colectomy
- This laparoscopic colectomy code describes an operation that creates an end colostomy and closes the distal bowel segment, not reversal of an existing enterostomy.
44227 billing questions
When is 44227 appropriate instead of an open enterostomy-closure code?
Use 44227 when the closure is performed laparoscopically, with resection of the stoma-bearing bowel and anastomosis. Open procedures are represented by different closure codes.
How does 44227 differ from closure without resection?
The operative report must support removal of the stoma-bearing bowel segment and restoration of continuity with an anastomosis. Closure without resection is represented by a different code.
Can modifier 50 be appended for a stoma closure?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this procedure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May 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.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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
Fee sheets
Put 44227 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →