Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Intestines (Except Rectum)CPT cpt-44640-intestinal-cutaneous-fistula-closure-with-resection
    Ask Trek AI about this page

    CPT 44640: Closure of Intestinal Cutaneous (Enterocutaneous) Fistula

    Medicare pays $1294 on average nationally for this procedure.

    CPT code 44640 describes surgical closure of an intestinal cutaneous fistula, including resection of damaged bowel and anastomosis as needed; the service is an operative abdominal procedure performed when nonsurgical management has failed, typically delivered in an inpatient or hospital operating room setting and documented as definitive surgical treatment of an enterocutaneous fistula.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

    Customize your policy alerts

    Sign up for cpt 44640 policy alerts

    Get alerted when payer policies referencing 44640 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 54-year-old patient with a chronic enterocutaneous fistula that has persisted despite optimized wound care, nutritional support, and negative-pressure therapy is scheduled for operative closure. The patient presents with localized skin breakdown, malodorous drainage, and intermittent small-bowel obstruction symptoms. Preoperative assessment includes nutritional optimization (often with parenteral nutrition), sepsis screening, and cross-sectional imaging to map fistula anatomy.

    In the operating room under general anesthesia, the surgical team performs adhesiolysis, resection of nonviable bowel segments if required, and primary anastomosis to restore bowel continuity. The fistula tract to the skin is excised and the skin and subcutaneous tissues are closed or reconstructed as indicated. Postoperative care includes infection surveillance, bowel function monitoring, pain control, wound management, and coordination with nutrition and wound care teams for gradual return to enteral feeding and monitoring for recurrent fistula or anastomotic leak.

    Typical documentation elements include operative note describing fistula location and size, bowel resection and anastomosis details (if performed), closure technique, drains placed, estimated blood loss, indications (failure of nonsurgical therapy), and relevant comorbidities that may affect healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44120Enterolysis (separating adhesions) with partial small bowel resectionPerformed when dense adhesions require lysis and limited resection during fistula closure.
    44121Enterolysis (separating adhesions) with major small bowel resectionUsed when extensive small-bowel resection is required as part of fistula management.
    49000Unlisted procedure, abdomen; drainage of peritoneal abscess or cavityMay be used when atypical drainage or abscess control procedures are required concomitantly.
    49900Unlisted laparoscopy procedure, abdomen, peritoneumUsed for laparoscopic approaches to fistula management when no specific laparoscopy code exists.
    44320Repair, enterotomy; singleMay be used for primary repair of an intestinal wall defect encountered during fistula surgery if resection/anastomosis not performed.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207L00000X
    363LF0000X
    246QM0706X
    226300000X
    261QM1103X
    224900000X
    224ZL0004X

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    A02.1Salmonella sepsis
    A09Infectious gastroenteritis and colitis, unspecified
    K35.80Unspecified acute appendicitis
    K57.10Diverticulosis of small intestine without perforation or abscess without bleeding
    K57.20Diverticulitis of large intestine with perforation and abscess without bleeding
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding
    K57.32Diverticulitis of large intestine without perforation or abscess without bleeding
    K57.33Diverticulitis of large intestine without perforation or abscess with bleeding
    K61.0Anal abscess
    K61.1Rectal abscess

    Showing 1–10 of 22

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-44602-SMALL-INTESTINE-REPAIR-WITH-PERITONEAL-IRRIGATION

    CPT 44602: Small Intestine Repair with Peritoneal Washout

    CPT-44603-SMALL-INTESTINE-SURGERY

    CPT 44603: Transanal Excision of Hemorrhoids

    CPT-44604-COLON-REPAIR-WITH-PERITONEAL-IRRIGATION

    CPT 44604: Repair of Large Intestine Tear with Abdominal Washout

    CPT-44605-COLON-REPAIR-WITH-COLOSTOMY

    CPT 44605: Repair of Large Intestine with Colostomy and Abdominal Irrigation

    CPT-44615-INTESTINAL-STRICTURE-REPAIR-ENTEROTOMY-ENTERORRHAPHY

    CPT 44615: Enterotomy/Enterorrhaphy for Intestinal Stricture

    CPT-44620-ENTEROSTOMY-CLOSURE

    CPT 44620: Closure of Enterostomy to Restore Bowel Continuity

    CPT-44625-ENTEROSTOMY-REVISION-SURGICAL-REPAIR

    CPT 44625: Revision of Enterostomy with Intestinal Reattachment

    CPT-44626-COLORECTAL-ANASTOMOSIS-ENTEROSTOMY-TAKEDOWN

    CPT 44626: Enterostomy Takedown with Colorectal Anastomosis

    CPT-44650-ENTERIC-FISTULA-CLOSURE

    CPT 44650: Enteroenteric / Enterocolic Fistula Closure

    CPT-44660-ENTEROVESICAL-FISTULA-CLOSURE

    CPT 44660: Enterovesical Fistula Closure

    Showing 1–10 of 12

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.