No office rate
Choose 44360 for diagnostic enteroscopy without lesion resection. Choose 44369 when the procedure report documents endoscopic mucosal resection.
On this page
CMS RVU26D · Effective 2026-10-01
44369 Small-bowel enteroscopy Medicare reimbursement rates in Wisconsin
Report this code when a gastroenterologist removes a small-bowel lesion by endoscopic mucosal resection during enteroscopy beyond the second part of the duodenum. Compare 44369 office and facility rates across CMS payment localities in Wisconsin.
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 44369 in Wisconsin?
Wisconsin 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
$202.54
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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.
Gastrointestinal endoscopy
About 44369: Antegrade small-bowel enteroscopy with mucosal resection
Report this code when a gastroenterologist removes a small-bowel lesion by endoscopic mucosal resection during enteroscopy beyond the second part of the duodenum.
This service combines an antegrade examination of the small intestine with endoscopic mucosal resection of a lesion. The endoscope passes through the mouth and beyond the second part of the duodenum, but the examination does not extend into the ileum. A gastroenterologist typically performs the procedure in a hospital outpatient department or ambulatory surgery center. The procedure report should identify the lesion’s location and describe the mucosal resection technique, which may include lifting the lesion and removing it with a snare.
Select this code from the documented technique, rather than from the presence of a polyp or a pathology specimen alone. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. Modifier 50 is inappropriate for this anatomy. Medicare pays an assistant at surgery only when medical necessity is documented; co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 44369
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.30 · 67%
- Practice expense (office) RVU1.69 · 26%
- Malpractice RVU0.47 · 7%
2.2K
Medicare services in 2024 · #2396 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.
44369 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
A biopsy samples tissue; endoscopic mucosal resection removes a lesion using a resection technique. The documented work distinguishes 44361 from 44369.
No office rate
Code 44370 describes enteroscopic stent placement. Code 44369 describes mucosal resection, not treatment by placing a stent.
Compare 44369 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$202.54
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 44369 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,395
- Code
- 44369
- Physician work
- 4.30
- Practice expense
- 1.69
- Malpractice
- 0.47
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.30 | × 1.000 | 4.3000 |
| Practice expense | 1.69 | × 0.958 | 1.6190 |
| Malpractice | 0.47 | × 0.308 | 0.1448 |
| Total RVUs | 6.0638 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$202.54
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.3 | 1 |
| Practice expense | 1.69 | 0.958 |
| Malpractice | 0.47 | 0.308 |
(4.3 × 1 + 1.69 × 0.958 + 0.47 × 0.308) × $33.4009 = $202.54
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.
44369 billing questions
Does a small-bowel biopsy support 44369?
No. Use 44369 when the report documents endoscopic mucosal resection; 44361 describes enteroscopy with biopsy.
What distinguishes 44369 from diagnostic enteroscopy?
Code 44369 requires documented mucosal resection of a lesion. Code 44360 describes the examination without that therapeutic work.
How is a related diagnostic enteroscopy paid when performed with 44369?
CMS applies endoscopy family pricing when related endoscopies are performed together. Review the procedures documented in the same session rather than treating each endoscopy as independently priced.
Should modifier 50 be added for more than one small-bowel lesion?
No. Modifier 50 is inappropriate for this service; document the lesions and the resection performed without treating them as bilateral sites.
Can an assistant surgeon be reported?
Medicare pays an assistant at surgery only when medical necessity is documented. Co-surgeon and team-surgery reporting are 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.
5,39244364,,Small bowel endoscopy,A,,3.54,1.47,NA,1.47,,0.39,5.40,5.40,0,000,0.00,0.00,0.00,3,0,0,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39344365,,Small bowel endoscopy,A,,3.13,1.34,NA,1.34,,0.35,4.82,4.82,0,000,0.00,0.00,0.00,3,0,0,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39444366,,Small bowel endoscopy,A,,4.19,1.66,NA,1.66,,0.45,6.30,6.30,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39544369,,Small bowel endoscopy,A,,4.30,1.69,NA,1.69,,0.47,6.46,6.46,0,000,0.00,0.00,0.00,3,0,0,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39644370,,Small bowel endoscopy/stent,A,,4.57,1.99,NA,1.99,,0.49,7.05,7.05,0,000,0.00,0.00,0.00,3,0,0,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39744372,,Small bowel endoscopy,A,,4.19,1.61,NA,1.61,,0.55,6.35,6.35,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
5,39844373,,Small bowel endoscopy,A,,3.31,1.36,NA,1.36,,0.43,5.10,5.10,0,000,0.00,0.00,0.00,3,0,1,0,0,9,44360,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,