CPT 44405
Global 000 ActiveColonoscopy w/dilation
CPT 44405 Billing & Documentation Guide
CPT code 44405 (Colonoscopy w/dilation) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.15, a non-facility practice expense RVU of 14.89, and a malpractice RVU of 0.36, a total non-facility RVU of 18.4 and facility RVU of 4.87. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $636.7, though rates vary from $538.62 to $840.39 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 44405, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 44405 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 44405 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 44405
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.15 | 3.15 |
| Practice Expense RVU | 14.89 | 1.36 |
| Malpractice RVU | 0.36 | 0.36 |
| Total RVU | 18.4 | 4.87 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 44405
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $703.99 | $169.25 | $658.53 - $840.39 | 29 |
| Florida | $627.62 | $174.2 | $598.74 - $653.35 | 3 |
| Georgia | $594.22 | $163.1 | $563.17 - $625.27 | 2 |
| Illinois | $609.11 | $172.45 | $578.08 - $638.02 | 4 |
| Michigan | $589.14 | $164.79 | $572.86 - $605.42 | 2 |
| North Carolina | $576.91 | $155.28 | $576.91 - $576.91 | 1 |
| New York | $681.38 | $177.23 | $586.14 - $725.61 | 5 |
| Ohio | $571.4 | $158.81 | $571.4 - $571.4 | 1 |
| Pennsylvania | $606.16 | $163.51 | $573.13 - $639.18 | 2 |
| Texas | $606.59 | $161.68 | $568.96 - $642.26 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 44405
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 44405 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 44405
What does CPT code 44405 mean? +
CPT code 44405 represents: Colonoscopy w/dilation. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 44405? +
The 2026 Medicare national average non-facility payment for CPT 44405 is $636.7. Rates range from $538.62 to $840.39 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 44405? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 44405? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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