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CPT code 45505: Rectal repair, transanal approach2026 Medicare rate & RVUs

Reports direct surgical closure of a rectal defect approached through the anal canal, such as a localized rectal injury accessible from below.

CMS RVU26DEffective Oct 1, 2026109 payment localities426 Medicare services in 2024

Medicare pays $594.20 for 45505 nationally in a facility.

Medicare rate · 45505

Rectal repair, transanal approach

Office or facility?

Work RVUs
8.15
Total RVUs
17.79
Global days
090

National rate · 2026

$594.20

Facility setting, before claim adjustments.

See every locality for 45505 →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 45505 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 45505 covers

This service involves reaching a rectal defect through the anal canal and closing it directly. A colorectal or general surgeon may perform it for a localized rectal wall injury or defect that can be exposed and repaired from below, typically in an operating room. The operative approach distinguishes this service from repairs requiring perineal or abdominal access.

Select the code from the approach and work documented, not from the diagnosis alone. The operative report should identify the rectal defect, its location, the transanal access, and the repair performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are 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 45505 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

45505 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$538.89
AlaskaUnavailable$726.17
ArizonaUnavailable$578.71
ArkansasUnavailable$532.03
Atlanta, GAUnavailable$609.19
Austin, TXUnavailable$605.03
Bakersfield, CAUnavailable$606.54
Baltimore area, MDUnavailable$630.06
Beaumont, TXUnavailable$566.15
Brazoria, TXUnavailable$583.19

45505 rates by state

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

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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
45505 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 45505 rate is calculated

Each of 45505’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 · 45505

RVUs × geographic indexes × conversion factor

Office or facility?

Work8.15

8.15 RVUs× 1.000 GPCI

Practice expense8.18

8.18 RVUs× 1.000 GPCI

Malpractice1.46

1.46 RVUs× 1.000 GPCI

Adjusted RVUs

17.7900

Conversion factor

$33.4009

Medicare rate

$594.20

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

Payment rules and modifiers for 45505

45505 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45505

Rectal repair, transanal approach

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)1Not paid (statutory restriction).
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 · 45505

Rectal repair, transanal approach

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

45505 without 51 · national facility

$594.20

Rectal repair, transanal approach

45505-51 · Second procedure: 50%

$297.10

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

45505 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 45505

    Rectal repair, transanal approach8.15 wRVU

    Not priced

  • 45500

    Rectal injury repair, injury-related proctoplasty7.54 wRVU

    Not priced

  • 45562

    Rectal injury repair, transabdominal exploration17.53 wRVU

    Not priced

  • 45563

    Rectal repair, with colostomy25.72 wRVU

    Not priced

  • 45520

    Rectal prolapse treatment, local treatment, any method0.54 wRVU

    $168.67

How to choose

45500Rectal injury repairInjury-related proctoplasty
Choose 45505 when the repair is reached through the anal canal; 45500 represents a perineal approach.
45562Rectal injury repairTransabdominal exploration
45562 describes exploration and repair through an abdominal approach. Use 45505 for a repair performed through the anal canal.
45563Rectal repairWith colostomy
45563 is an abdominal exploration-and-repair option; 45505 is selected for the transanal approach.
45520Rectal prolapse treatmentLocal treatment, any method
45520 addresses treatment of rectal prolapse, not direct closure of a rectal defect or injury.

Codes related to 45505

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

Codes related to 45505
CodeHow it relatesNational office range
Same family
45500Rectal injury repair, injury-related proctoplastyRectal repair reached through a perineal approach rather than through the anal canal.No office rate
Used instead
45562Rectal injury repair, transabdominal explorationAbdominal exploration and repair may fit when the rectum is approached transabdominally.No office rate
45563Rectal repair, with colostomyA transabdominal exploration-and-repair option for a different operative approach.No office rate

45505 billing questions

How does this differ from 45500?

The approach is the key distinction: 45505 is for repair reached through the anal canal, while 45500 represents a perineal approach. The operative report should support the approach used.

When would an abdominal repair code be more appropriate?

Use the applicable abdominal exploration-and-repair code when the surgeon explores and repairs the rectum through an abdominal approach. Codes 45562 and 45563 are alternatives to consider for that operative circumstance.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50 for the rectal repair.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The global period is tied to this major surgery.

What documentation supports reporting 45505?

Document the rectal defect or injury, the transanal route used to reach it, and the repair performed. Those details distinguish this service from perineal or abdominal repair.

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 45505PPRRVU2026_Oct_nonQPP.csv, line 5,538 (RVU26D)

Open CMS sourceHow we calculate rates

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