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CPT code 45500: Rectal injury repair, injury-related proctoplasty2026 Medicare rate & RVUs

Surgical proctoplasty repairs an injury to the rectum, including anorectal sphincter repair when needed, during an operative encounter.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $570.15 for 45500 nationally in a facility.

Medicare rate · 45500

Rectal injury repair, injury-related proctoplasty

Office or facility?

Work RVUs
7.54
Total RVUs
17.07
Global days
090

National rate · 2026

$570.15

Facility setting, before claim adjustments.

See every locality for 45500 →Billed by an NP, PA or therapist? →

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

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 45500 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 45500 covers

This operation repairs an injured rectum through a proctoplasty approach; the repair may also involve the anorectal sphincter when that structure is injured. It is typically performed by a colorectal or general surgeon in an operating room for a rectal injury requiring operative repair. The operative report should identify the injury and describe the repair performed, including any sphincter repair.

Report 45500 when the documented service is injury-related proctoplasty, rather than reconstruction for rectal narrowing or repair through a different operative approach. The Medicare global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 multiple procedure reduction. Assistant-at-surgery payment requires documentation of medical necessity.

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 45500 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

45500 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$509.62
AlaskaUnavailable$682.26
ArizonaUnavailable$552.70
ArkansasUnavailable$502.18
Atlanta, GAUnavailable$588.42
Austin, TXUnavailable$577.57
Bakersfield, CAUnavailable$572.80
Baltimore area, MDUnavailable$608.43
Beaumont, TXUnavailable$542.78
Brazoria, TXUnavailable$555.14

45500 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
45500 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 45500 rate is calculated

Each of 45500’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 · 45500

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.54

7.54 RVUs× 1.000 GPCI

Practice expense7.52

7.52 RVUs× 1.000 GPCI

Malpractice2.01

2.01 RVUs× 1.000 GPCI

Adjusted RVUs

17.0700

Conversion factor

$33.4009

Medicare rate

$570.15

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 45500

45500 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45500

Rectal injury repair, injury-related proctoplasty

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 45500

Rectal injury repair, injury-related proctoplasty

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

45500 without 51 · national facility

$570.15

Rectal injury repair, injury-related proctoplasty

45500-51 · Second procedure: 50%

$285.08

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%).

When to use modifier 51

45500 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 45500

    Rectal injury repair, injury-related proctoplasty7.54 wRVU

    Not priced

  • 45505

    Rectal repair, transanal approach8.15 wRVU

    Not priced

  • 45562

    Rectal injury repair, transabdominal exploration17.53 wRVU

    Not priced

  • 45563

    Rectal repair, with colostomy25.72 wRVU

    Not priced

How to choose

45505Rectal repairTransanal approach
Choose 45500 for injury-related proctoplasty; 45505 is for proctoplasty to address rectal stenosis.
45562Rectal injury repairTransabdominal exploration
45562 describes transabdominal exploration and repair of a rectal injury. Use 45500 when the documented operation is the injury-related proctoplasty.
45563Rectal repairWith colostomy
45563 describes transabdominal exploration and rectal injury repair with a colostomy. 45500 represents injury-related proctoplasty instead.

Codes related to 45500

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 45500
CodeHow it relatesNational office range
Same family
45505Rectal repair, transanal approachRelated proctoplasty code for rectal stenosis rather than injury.No office rate
Used instead
45562Rectal injury repair, transabdominal explorationUsed for transabdominal exploration and repair of rectal injury.No office rate
45563Rectal repair, with colostomyTransabdominal exploration and rectal injury repair when a colostomy is also performed.No office rate

45500 billing questions

How does 45500 differ from 45505?

45500 is for proctoplasty to repair an injury. 45505 is the related proctoplasty code for treatment of rectal stenosis.

When is 45562 a better fit?

Consider 45562 when the documented service is transabdominal exploration and repair of a rectal injury, rather than the proctoplasty represented by 45500.

Are related postoperative visits separately reported?

The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.

When can an assistant at surgery be reported?

Medicare assistant-at-surgery payment requires documentation that the assistant was medically necessary.

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
RVUs for 45500PPRRVU2026_Oct_nonQPP.csv, line 5,537 (RVU26D)

Open CMS sourceHow we calculate rates

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