CPT code 45130: Rectal prolapse repair, perineal mucosal excision2026 Medicare rate & RVUs in Massachusetts
Reports perineal repair of rectal prolapse using mucosal excision and muscle plication, commonly performed as a Delorme procedure.
CMS doesn’t publish an office rate for 45130 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 45130 covers
A colorectal or general surgeon may perform this perineal operation for rectal prolapse using a Delorme technique. The surgeon separates and removes a sleeve of prolapsed rectal mucosa, plicates the underlying rectal muscle, and closes the mucosa. The repair addresses the prolapse without the rectal and sigmoid resection associated with an Altemeier procedure. It is generally performed in an operating room under anesthesia.
Report the code when the operative note supports perineal mucosal excision and muscle plication for prolapse. Document the prolapse, operative approach, and work performed so the service can be distinguished from perineal resection or rectopexy. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
Where 45130 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $1,074.52 |
| Rest of Massachusetts | Unavailable | $1,007.95 |
How the 45130 rate is calculated
Each of 45130’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45130
RVUs × geographic indexes × conversion factor
Work18.04
18.04 RVUs× 1.000 GPCI
Practice expense8.80
8.80 RVUs× 1.000 GPCI
Malpractice3.24
3.24 RVUs× 1.000 GPCI
Adjusted RVUs
30.0800
Conversion factor
$33.4009
Medicare rate
$1,004.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45130
45130 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45130
Rectal prolapse repair, perineal mucosal excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 45130
Rectal prolapse repair, perineal mucosal excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45130 without 51 · national facility
$1,004.70
Rectal prolapse repair, perineal mucosal excision
45130-51 · Second procedure: 50%
$502.35
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45130 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45135Rectal prolapse excisionAbdominal approach
- Choose 45130 for perineal mucosal excision and muscle plication without rectal resection. Choose 45135 when the perineal operation includes rectal resection.
- 45505Rectal repairTransanal approach
- Code 45505 describes mucosal proctoplasty for prolapse. This code represents a Delorme-type excision and plication repair.
- 45540Rectal prolapse repairAbdominal approach
- Code 45540 describes abdominal rectopexy, which fixes the rectum rather than excising a mucosal sleeve through a perineal approach.
45130 billing questions
How is this code distinguished from 45135?
This code describes a perineal mucosal excision with muscle plication, as in a Delorme procedure. Code 45135 describes perineal prolapse surgery with rectal resection, as in an Altemeier procedure.
Which operative details support reporting this code?
Document rectal prolapse, the perineal approach, mucosal sleeve excision, and plication of the underlying muscle. The note should make clear whether rectal resection was performed.
Can the mucosal excision and muscle plication be reported separately?
They are integral steps of the prolapse repair represented by this code, not separate procedures to report individually.
Should modifier 50 be appended for prolapse on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How does CMS treat an assistant or co-surgeon?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 45130 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet