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

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 Puerto Rico, Medicare pays $170.27 for 45520 in the office and $37.90 when it’s performed in a hospital or facility.

$170.27Office (non-facility)
$37.90Hospital or facility
+0.9%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $170.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

45520 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$170.27
  2. Los Angeles, CA · California$195.77+$25.50
  3. Washington, DC area · District of Columbia$196.31+$26.04
  4. Miami, FL · Florida$178.33+$8.06
  5. Chicago, IL · Illinois$172.57+$2.30
  6. Manhattan, NY · New York$195.22+$24.95
  7. Alaska · Alaska$186.28+$16.01

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

Every other payment area

45520 in every other Medicare payment locality
Payment localityOfficeFacility
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
Fresno, CACalifornia$182.13$38.63
Hanford, CACalifornia$182.13$38.63

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 45520 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work0.54× 1.0000.5400
Practice expense4.44× 1.0114.4888
Malpractice0.07× 0.9850.0690
Total RVUs5.0978
Conversion factor× 33.4009

Office rate, Puerto Rico$170.27

Office: (0.54 × 1 + 4.44 × 1.011 + 0.07 × 0.985) × $33.4009 = $170.27

Facility: (0.54 × 1 + 0.52 × 1.011 + 0.07 × 0.985) × $33.4009 = $37.90

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, Puerto Rico
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 Puerto Rico

45520 · Office / nonfacility

$170.27

Effective 2026-10-01

The base rate is $16.37 higher than on 2025-10-01, moving from $153.90 to $170.27 (10.6%).

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

    $153.90changed to$170.27

    • 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 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $162.72changed to$153.90

    • 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

    $160.07changed to$162.72

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $167.85changed to$160.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.30 changed to 4.24
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $166.73changed to$167.85

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $171.41changed to$166.73

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $174.96changed to$171.41

    • 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.

  8. January 1, 2021

    RVU21A

    $161.67changed to$174.96

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $159.86changed to$161.67

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.78 changed to 3.82
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $161.86changed to$159.86

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $138.09changed to$161.86

    • 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
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $117.61changed to$138.09

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.85 changed to 3.80
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $119.70changed to$117.61

    • 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.

  14. July 1, 2015

    RVU15C

    $119.11changed to$119.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $115.57changed to$119.11

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $118.73changed to$115.57

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.31 changed to 3.84
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $118.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$170.27$37.90RVU26D
2026-07-01$170.27$37.90RVU26C
2026-04-01$170.27$37.90RVU26B
2026-01-01$170.27$37.90RVU26A
2025-10-01$153.90$39.57RVU25D
2025-07-01$153.90$39.57RVU25C
2025-04-01$153.90$39.57RVU25B
2025-01-01$153.90$39.57RVU25A
2024-10-01$162.72$40.71RVU24D
2024-07-01$162.72$40.71RVU24C
2024-04-01$162.72$40.71RVU24B
2024-03-09$162.72$40.71RVU24AR
2024-01-01$160.07$40.04RVU24A
2023-10-01$167.85$40.78RVU23D
2023-07-01$166.73$40.66RVU23C
2023-04-01$166.73$40.66RVU23B
2023-01-01$166.73$40.66RVU23A
2022-10-01$171.41$40.95RVU22D
2022-07-01$171.41$40.95RVU22C
2022-04-01$171.41$40.95RVU22B
2022-01-01$171.41$40.95RVU22A
2021-10-01$174.96$40.25RVU21D
2021-07-01$174.96$40.25RVU21C
2021-04-01$174.96$40.25RVU21B
2021-01-01$174.96$40.25RVU21A
2020-10-01$161.67$41.62RVU20D
2020-07-01$161.67$41.62RVU20C
2020-04-01$161.67$41.62RVU20B
2020-01-01$161.67$41.62RVU20A
2019-10-01$159.86$41.91RVU19D
2019-07-01$159.86$41.91RVU19C
2019-04-01$159.86$41.91RVU19B
2019-01-01$159.86$41.91RVU19A
2018-10-01$161.86$42.23RVU18D
2018-07-01$161.86$42.23RVU18C
2018-04-01$161.86$42.23RVU18B
2018-01-01$161.86$42.23RVU18AR1
2017-10-01$138.09$38.25RVU17D
2017-07-01$138.09$38.25RVU17C
2017-04-01$138.09$38.25RVU17B
2017-01-01$138.09$38.25RVU17A
2016-10-01$117.61$34.06RVU16D
2016-07-01$117.61$34.06RVU16C
2016-04-01$117.61$34.06RVU16B
2016-01-01$117.61$34.06RVU16A
2015-10-01$119.70$34.33RVU15D
2015-07-01$119.70$34.33RVU15C
2015-04-01$119.11$34.16RVU15B
2015-01-01$119.11$34.16RVU15A
2014-10-01$115.57$34.02RVU14D
2014-07-01$115.57$34.02RVU14C
2014-04-01$115.57$34.02RVU14B
2014-01-01$115.57$34.02RVU14A
2013-10-01$118.73$33.15RVU13D
2013-07-01$118.73$33.15RVU13C
2013-04-01$118.73$33.15RVU13B
2013-01-01$118.73$33.15RVU13AR

Price 45520 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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