CPT CODESurgery (Digestive)Status A

CPT Code 44204Complete Billing & Coding Guide (2026)Laparo partial colectomy

Reviewed by AAPC-Certified Coders2026 Medicare Fee ScheduleCMS + AMA Sources
Medicare Payment
$1413
Non-facility · National avg
Facility
$1413
Total RVU
42.31
Global
090
Payment
$1413
non-facility
Work RVU
25.76
physician effort
Global Period
090
post-op days
Bundling Edits
10
NCCI pairs

About CPT 44204

CPT 44204 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Laparo partial colectomy". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

Major surgical codes carry a 90-day global period that bundles all related post-operative care. Improper billing of post-op E/M (without modifier 24 for unrelated care) is a common audit finding. Documentation of medical necessity for the procedure itself remains the foundation of any successful claim.

Pro Tip

CPT 44204 has a 90-day global period. Any E/M visit within that window for the same condition is bundled into the procedure payment. Use modifier 24 for unrelated E/M, modifier 79 for unrelated procedures, and modifier 78 for related returns to the OR.

Code Properties

Global Period
090
90-day global period
Status Indicator
A
Active. Payment under Medicare PFS.
Conversion Factor
$33.4009
CMS national rate
Effective Date
2026-04-01
per CMS publication

RVU Breakdown

Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.

RVU Composition
42.31 total RVU
25.76
10.80
5.75
Work RVU
25.76 · 61%
Physician time + skill
Practice Expense
10.80 · 26%
Office & equipment
Malpractice
5.75 · 14%
Liability insurance
Non-Facility
Private office · urgent care · ambulatory
Most billed
$1413.19
42.31 RVU × $33.4009 CF
Facility
Hospital · ASC · nursing home
$1413.19
42.31 RVU × $33.4009 CF

Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.

Medicare Payment by State

Medicare adjusts payment by locality based on GPCI (Geographic Practice Cost Index). Higher cost-of-living areas like California and New York pay more. Rural states pay less. Top 12 states shown.

AK
$1781
FL
$1596
IL
$1579
NY
$1565
DC
$1546
NJ
$1519
CT
$1499
MI
$1469
MD
$1455
MA
$1452
WA
$1450
WV
$1449

Showing top 12 of 53 states. Full locality data available in CMS PFS Locality file.

NCCI Bundling Edits

10 pairs

These codes trigger National Correct Coding Initiative edits when billed with 44204. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.

Common Denial Risk

Billing 44204 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.

AR Recovery Note

Multi-procedure NCCI edits hit surgical specialties harder than any other category. CO-97 denials on 44204 are frequently recoverable when the operative note documents distinct anatomic sites or staged steps. Our coders read the op note against the edit pair and pick the right modifier (XS preferred over modifier 59 for distinct structures).

Applicable Modifiers

Modifiers commonly paired with 44204 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.

22
Increased procedural services — work substantially greater than typically required
When to use · When the work required for a procedure is substantially more than usual (e.g., morbid obesity, extensive adhesions, unusual anatomy). Request additional payment.
33
Preventive services — when the primary purpose is delivery of an evidence-based service per USPSTF A or B recommendation
When to use · Screening services (colonoscopy, mammography, etc.) to indicate the primary purpose is preventive. Waives cost-sharing under ACA.
50
Bilateral procedure — performed on both sides of the body during the same operative session
When to use · When a procedure is performed on both sides (e.g., bilateral knee injections, bilateral cataract surgery). Payment = 150% of unilateral rate.
51
Multiple procedures — when multiple procedures (other than E/M) are performed at the same session
When to use · Second and subsequent procedures during the same session. Payment is typically reduced to 50% for the 2nd procedure, 25% for the 3rd+.
52
Reduced services — when a procedure is partially reduced or eliminated at the physician's discretion
When to use · When a procedure is not completed to its full extent (e.g., incomplete colonoscopy that didn't reach cecum). Payment reduced by payer discretion.
53
Discontinued procedure — physician elected to terminate/discontinue a procedure due to patient risk
When to use · When a surgical procedure is started but discontinued due to patient safety concerns (e.g., anesthesia complications, intraoperative findings).
54
Surgical care only
When to use · When the surgeon provided ONLY the surgery, not pre/post op care
55
Postoperative management only
When to use · When you managed post-op but another physician performed the surgery
AR Recovery Note

Modifier 24, 79, 78, and 58 on global-period claims are the highest-recovery surgical billing levers. 44204 carries a 090 global indicator. Our team flags every encounter inside an active global period for the right modifier decision.

Free 90-Day AR Recovery Audit

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Wrong modifier, missing documentation, bundling without justification, stale ICD-10 linkage: these are the silent revenue killers on Surgery (Digestive) claims. Our AAPC-certified team audits your last 90 days of 44204 claims, surfaces the recoverable dollars, and appeals them. Free, no obligation.

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FAQ

Everything about CPT 44204

What does CPT code 44204 cover?

CPT 44204 is a Current Procedural Terminology code in the Surgery (Digestive) category maintained by the American Medical Association. The CMS short descriptor reads "Laparo partial colectomy". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.

What is the Medicare payment for CPT 44204?

The national average Medicare payment for CPT 44204 is approximately $1413.19 in a non-facility setting and $1413.19 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 42.31 with a conversion factor of $33.4009.

What is the global period for CPT 44204?

CPT 44204 has a 90-day global period (indicator 090). Routine post-op care for the next 90 days is bundled into the procedure payment, including all related E/M visits. Bill modifier 24 for unrelated E/M, modifier 79 for unrelated procedures, or modifier 78 for related returns to the OR during this window.

What codes bundle with CPT 44204?

CPT 44204 has NCCI Procedure-to-Procedure edits with 10+ codes including 0213T, 0216T, 0596T. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.

CMS Medicare Physician Fee ScheduleNCCI Edits · Current QuarterAMA CPT Code Set

CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.

Free 90-Day AR Recovery Audit

We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.