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

Reports a local treatment for rectal prolapse, such as injection therapy, rather than a formal abdominal or perineal prolapse repair.

CMS RVU26DEffective Oct 1, 2026One payment locality186 Medicare services in 2024

In Chicago, IL, Medicare pays $172.57 for 45520 in the office and $40.98 when it’s performed in a hospital or facility.

$172.57Office (non-facility)
$40.98Hospital or facility
+2.3%vs the national office rate ($168.67)

Check a contract rate as a % of Medicare · 45520 nationwide

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

We’ll open 45520 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Chicago, IL
  2. What 45520 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Chicago, IL compares for 45520

Across 109 of 109 payment localities, the office rate for 45520 runs from $146.63 in Arkansas to $235.12 in San Benito County, CA. Chicago, IL pays $172.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

45520 in Chicago, IL vs other payment areas
  1. Chicago, IL · this page$172.57
  2. East St. Louis, IL · Illinois$159.18−$13.39
  3. Rest of Illinois · Illinois$157.09−$15.48
  4. Suburban Chicago, IL · Illinois$174.61+$2.04
  5. Los Angeles, CA · California$195.77+$23.20
  6. Washington, DC area · District of Columbia$196.31+$23.74
  7. Miami, FL · Florida$178.33+$5.76

Other areas in Illinois first, then benchmark localities. Bars start at $0.

Every other payment area

45520 in every other Medicare payment locality
Payment localityOfficeFacility
Manhattan, NYNew York$195.22$43.08
AlaskaAlaska$186.28$46.84
AlabamaAlabama$149.12$34.56
ArkansasArkansas$146.63$34.16
ArizonaArizona$163.74$36.87
Bakersfield, CACalifornia$182.34$38.84
Chico, CACalifornia$182.13$38.63
El Centro, CACalifornia$182.14$38.64

45520 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$146.63

$208.63

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
45520 office rate range by state
State / territoryOffice rate rangeLocalities
AK$186.281
AL$149.121
AR$146.631
AZ$163.741
CA$182.13–$235.1229
CO$177.871
CT$180.951
DC$196.311
DE$166.751
FL$163.33–$178.333
GA$153.11–$171.572
GU$188.011
HI$188.011
IA$154.661
ID$155.581
IL$157.09–$174.614
IN$156.651
KS$153.281
KY$152.011
LA$151.52–$160.242
MA$176.35–$197.932
MD$170.44–$196.313
ME$155.93–$166.482
MI$156.07–$165.092
MN$171.331
MO$148.15–$161.563
MS$147.451
MT$168.671
NC$157.891
ND$167.291
NE$155.801
NH$174.461
NJ$183.27–$193.702
NM$156.841
NV$168.431
NY$160.57–$199.865
OH$155.791
OK$152.291
OR$167.39–$184.832
PA$156.39–$175.532
PR$170.271
RI$173.661
SC$157.051
SD$167.121
TN$154.101
TX$155.16–$177.058
UT$159.541
VA$165.47–$196.312
VI$170.271
VT$166.041
WA$176.21–$202.812
WI$160.831
WV$150.251
WY$168.071

See 45520 in every payment locality

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.

How the rate is built · 45520

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.54

0.54 RVUs× 1.000 GPCI

Practice expense4.44

4.44 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

5.0500

Conversion factor

$33.4009

Medicare rate

$168.67

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

The exact Chicago, IL inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,541

Code
45520
Physician work
0.54
Practice expense
4.44
Malpractice
0.07

GPCI2026.csv

48

Locality
Chicago, IL
Physician work
1.007
Practice expense
1.005
Malpractice
2.295
Office calculation for 45520 in Chicago, IL
ComponentRVULocality factorAdjusted
Physician work0.54× 1.0070.5438
Practice expense4.44× 1.0054.4622
Malpractice0.07× 2.2950.1607
Total RVUs5.1666
Conversion factor× 33.4009

Office rate, Chicago, IL$172.57

Office: (0.54 × 1.007 + 4.44 × 1.005 + 0.07 × 2.295) × $33.4009 = $172.57

Facility: (0.54 × 1.007 + 0.52 × 1.005 + 0.07 × 2.295) × $33.4009 = $40.98

Open 45520 in the RVU calculator

Payment rules and modifiers for 45520

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

CMS payment indicators · 45520

Rectal prolapse treatment, local treatment, any method

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

45520 without 51 · national office

$168.67

Rectal prolapse treatment, local treatment, any method

45520-51 · Second procedure: 50%

$84.34

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

Codes related to 45520

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

Codes related to 45520
CodeHow it relatesOffice range, Chicago, IL
Used instead
45540Rectal prolapse repair, abdominal approachAbdominal approach repair for rectal prolapse rather than local treatment.No office rate
45541Prolapse repair, perineal approachPerineal approach repair for rectal prolapse rather than local treatment.No office rate
45550Rectal repair, with sigmoid resectionAbdominal prolapse repair that includes sigmoid resection.No office rate

How 45520 has changed in Chicago, IL

45520 · Office / nonfacility

$172.57

Effective 2026-10-01

The base rate is $14.41 higher than on 2025-10-01, moving from $158.16 to $172.57 (9.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $158.16changed to$172.57

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.55 changed to 0.54
    • Practice expense RVU 4.12 changed to 4.44
    • Malpractice RVU 0.06 changed to 0.07
    • Practice expense GPCI 1.023 changed to 1.005
    • Malpractice GPCI 2.018 changed to 2.295

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $167.52changed to$158.16

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.24 changed to 4.12
    • Malpractice RVU 0.07 changed to 0.06

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $164.79changed to$167.52

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $173.94changed to$164.79

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.30 changed to 4.24
    • Work GPCI 1.009 changed to 1.007
    • Practice expense GPCI 1.033 changed to 1.023
    • Malpractice GPCI 1.945 changed to 2.018

  5. January 1, 2023

    RVU23A

    $179.42changed to$173.94

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.29 changed to 4.30
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 1.044 changed to 1.033
    • Malpractice GPCI 1.871 changed to 1.945

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $182.51changed to$179.42

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.37 changed to 4.29
    • Malpractice RVU 0.06 changed to 0.08

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $168.75changed to$182.51

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.82 changed to 4.37
    • Malpractice RVU 0.08 changed to 0.06
    • Work GPCI 1.009 changed to 1.011
    • Practice expense GPCI 1.039 changed to 1.044
    • Malpractice GPCI 1.898 changed to 1.871

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $166.39changed to$168.75

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.78 changed to 3.82
    • Work GPCI 1.008 changed to 1.009
    • Practice expense GPCI 1.034 changed to 1.039
    • Malpractice GPCI 1.925 changed to 1.898

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $168.44changed to$166.39

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.84 changed to 3.78

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $166.22changed to$168.44

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.80 changed to 3.84
    • Malpractice RVU 0.07 changed to 0.08
    • Work GPCI 1.012 changed to 1.008
    • Practice expense GPCI 1.036 changed to 1.034
    • Malpractice GPCI 1.972 changed to 1.925

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $168.01changed to$166.22

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.85 changed to 3.80
    • Work GPCI 1.016 changed to 1.012
    • Practice expense GPCI 1.037 changed to 1.036
    • Malpractice GPCI 2.019 changed to 1.972

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $170.50changed to$168.01

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.92 changed to 3.85
    • Malpractice RVU 0.06 changed to 0.07

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $169.66changed to$170.50

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $168.90changed to$169.66

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.84 changed to 3.92
    • Malpractice RVU 0.07 changed to 0.06
    • Work GPCI 1.023 changed to 1.016
    • Practice expense GPCI 1.044 changed to 1.037
    • Malpractice GPCI 2.048 changed to 2.019

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $178.34changed to$168.90

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.31 changed to 3.84
    • Work GPCI 1.030 changed to 1.023
    • Practice expense GPCI 1.051 changed to 1.044
    • Malpractice GPCI 2.077 changed to 2.048

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$178.34

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$172.57$40.98RVU26D
2026-07-01$172.57$40.98RVU26C
2026-04-01$172.57$40.98RVU26B
2026-01-01$172.57$40.98RVU26A
2025-10-01$158.16$42.02RVU25D
2025-07-01$158.16$42.02RVU25C
2025-04-01$158.16$42.02RVU25B
2025-01-01$158.16$42.02RVU25A
2024-10-01$167.52$43.57RVU24D
2024-07-01$167.52$43.57RVU24C
2024-04-01$167.52$43.57RVU24B
2024-03-09$167.52$43.57RVU24AR
2024-01-01$164.79$42.86RVU24A
2023-10-01$173.94$43.72RVU23D
2023-07-01$173.94$43.72RVU23C
2023-04-01$173.94$43.72RVU23B
2023-01-01$173.94$43.72RVU23A
2022-10-01$179.42$44.29RVU22D
2022-07-01$179.42$44.29RVU22C
2022-04-01$179.42$44.29RVU22B
2022-01-01$179.42$44.29RVU22A
2021-10-01$182.51$42.99RVU21D
2021-07-01$182.51$42.99RVU21C
2021-04-01$182.51$42.99RVU21B
2021-01-01$182.51$42.99RVU21A
2020-10-01$168.75$45.01RVU20D
2020-07-01$168.75$45.01RVU20C
2020-04-01$168.75$45.01RVU20B
2020-01-01$168.75$45.01RVU20A
2019-10-01$166.39$45.28RVU19D
2019-07-01$166.39$45.28RVU19C
2019-04-01$166.39$45.28RVU19B
2019-01-01$166.39$45.28RVU19A
2018-10-01$168.44$45.60RVU18D
2018-07-01$168.44$45.60RVU18C
2018-04-01$168.44$45.60RVU18B
2018-01-01$168.44$45.60RVU18AR1
2017-10-01$166.22$45.38RVU17D
2017-07-01$166.22$45.38RVU17C
2017-04-01$166.22$45.38RVU17B
2017-01-01$166.22$45.38RVU17A
2016-10-01$168.01$45.12RVU16D
2016-07-01$168.01$45.12RVU16C
2016-04-01$168.01$45.12RVU16B
2016-01-01$168.01$45.12RVU16A
2015-10-01$170.50$44.93RVU15D
2015-07-01$170.50$44.93RVU15C
2015-04-01$169.66$44.70RVU15B
2015-01-01$169.66$44.70RVU15A
2014-10-01$168.90$45.86RVU14D
2014-07-01$168.90$45.86RVU14C
2014-04-01$168.90$45.86RVU14B
2014-01-01$168.90$45.86RVU14A
2013-10-01$178.34$45.68RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 45520 for an earlier date of service

Where the Chicago, IL rate applies

Chicago, IL is a Medicare payment area, not a city. Our Census mapping connects it to 137 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Illinois

45520 billing questions

When should this code be chosen over a prolapse repair code?

Use it for a local treatment, such as injection therapy, rather than a formal abdominal or perineal repair. Select a repair code when the operative service matches that approach and repair.

What documentation supports reporting this service?

Document the rectal prolapse, the method used to treat it, and the work performed. The record should make clear that the service was not an abdominal or perineal repair.

Is same-day care included in the service?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

Can modifier 50 or an assistant-at-surgery claim be reported?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.

How is this code affected when another procedure is 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.

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 45520PPRRVU2026_Oct_nonQPP.csv, line 5,541 (RVU26D)
Geographic factors for Chicago, ILGPCI2026.csv, line 48 (RVU26D)

Open CMS sourceHow we calculate rates

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