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    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the Intestines (Except Rectum)CPT cpt-44650-enteric-fistula-closure
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    CPT 44650: Enteroenteric / Enterocolic Fistula Closure

    Medicare pays $1334 on average nationally for this procedure.

    CPT code 44650 describes surgical closure of an enteroenteric or enterocolic fistula — a procedure to close an abnormal connection between two segments of the small intestine or between the small and large intestine to treat or prevent infection, abscess, and other complications; service type: surgical enteric fistula repair; typical site of service: inpatient or hospital-based operating room for abdominal surgery.

    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.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 58-year-old male with a chronic postoperative enterocutaneous fistula that communicates between a segment of small intestine and the colon, presenting with persistent drainage, recurrent intra-abdominal infection, and malnutrition despite conservative management. The surgical team evaluates enteric continuity and local tissue viability, obtains cross-sectional imaging (CT abdomen/pelvis with oral and IV contrast) and nutritional optimization, and discusses operative repair. In the operating room under general anesthesia, the surgeon performs adhesiolysis, isolates the fistulous tract, debrides inflamed margins, and performs primary takedown and closure of the enteroenteric or enterocolic fistula with layered intestinal repair or resection with anastomosis if required. Intraoperative cultures and pathology specimens may be obtained. Postoperative workflow includes monitoring for leak or abscess, bowel rest with nasogastric decompression as needed, broad-spectrum antibiotics guided by cultures, venous thromboembolism prophylaxis, pain control, and gradual advancement of diet. Discharge planning addresses wound care, stoma education if diversion was created, and outpatient follow-up for nutrition and infection surveillance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44120Enterolysis (separate procedure) — small intestinePerformed preoperatively or intraoperatively for extensive adhesions to expose the fistula prior to fistula takedown.
    44121Colectomy, partial; with anastomosis (small intestine to colon anastomosis)Performed when resection of diseased bowel segments with primary anastomosis is required as part of fistula management.
    44140Colectomy, partial; with colostomy or ileostomyUsed when a diversion (stoma) is created to protect a repair or control sepsis.
    49420Placement of peritoneal drainage catheterPerformed when intra-abdominal abscess drainage is required in conjunction with fistula treatment.
    44970Laparoscopy, surgical; enterolysisPerformed laparoscopically in selected cases to manage adhesions and access fistula tracts.

    Related Modifiers

    8 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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    163WX0106X
    104100000X
    3416L0300X
    207UN0902X
    281P00000X
    2279E1000X
    146L00000X
    246ZI1000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    A09Infectious gastroenteritis and colitis, unspecified
    K35.80Unspecified acute appendicitis
    K50.90Crohn's disease, unspecified, without complications
    K51.90Ulcerative colitis, unspecified, without complications
    K56.7Ileus, unspecified
    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

    Showing 1–10 of 23

    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-44640-INTESTINAL-CUTANEOUS-FISTULA-CLOSURE-WITH-RESECTION

    CPT 44640: Closure of Intestinal Cutaneous (Enterocutaneous) Fistula

    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.
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