CPT code 45520: Rectal prolapse treatment, local treatment, any method2026 Medicare rate & RVUs

Medicare pays $168.67 for 45520 nationally in the office and $37.74 in a hospital or facility. Local office rates run $146.63–$235.12.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 45520 covers

This service covers a treatment directed at rectal prolapse without the formal abdominal or perineal repair described by the related repair codes. A colorectal or general surgeon may perform a local treatment, such as injection therapy, in an outpatient setting. The record should identify the prolapse and the treatment method performed so the service can be distinguished from repair of the rectum or surgery to correct prolapse through an abdominal or perineal approach.

Report the service based on the treatment actually performed, not simply the diagnosis of prolapse. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; 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 45520 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

45520 rates by state

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

How the 45520 rate is calculated

Each of 45520’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.

Payment rules and modifiers for 45520

The CMS indicators that decide how 45520 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

45520 compared with similar codes

How to choose

45540Rectal prolapse repairAbdominal approach

Choose 45540 for repair of rectal prolapse through an abdominal approach; this code describes local treatment rather than that formal repair.

45541Prolapse repairPerineal approach

Choose 45541 when the prolapse is repaired through a perineal approach. This code is for local treatment, not that approach-specific repair.

45550Rectal repairWith sigmoid resection

45550 describes abdominal prolapse repair that includes sigmoid resection. This code does not represent that combined repair.

Codes related to 45520

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

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

Open CMS sourceHow we calculate rates