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CPT code 45540: Rectal prolapse repair, abdominal approach2026 Medicare rate & RVUs

Reported for an abdominal operation that repairs rectal prolapse without the sigmoid resection included in a separate code.

CMS RVU26DEffective Oct 1, 2026109 payment localities328 Medicare services in 2024

Medicare pays $974.30 for 45540 nationally in a facility.

Medicare rate · 45540

Rectal prolapse repair, abdominal approach

Office or facility?

Work RVUs
17.67
Total RVUs
29.17
Global days
090

National rate · 2026

$974.30

Facility setting, before claim adjustments.

See every locality for 45540 →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 45540 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 45540 covers

A surgeon uses an abdominal approach to restore and support a prolapsing rectum, commonly by securing it within the pelvis as a rectopexy. The operation is performed for rectal prolapse and is typically done in a hospital operating room by a colorectal or general surgeon. The abdominal approach distinguishes this service from repair through the perineum and from laparoscopic rectopexy codes.

Select this code when the operative report documents an abdominal repair without sigmoid resection; use the separate resection code when sigmoid resection is part of the operation. The report should identify the prolapse, approach, repair performed, and any resection. The day-before preoperative visit and 90 days of related postoperative care are included. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Report the repair once; modifier 50 is not appropriate. Assistant-at-surgery payment may be available, co-surgeon payment requires supporting documentation, and team-surgery payment is 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 45540 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

45540 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$893.47
AlaskaUnavailable$1,239.77
ArizonaUnavailable$950.39
ArkansasUnavailable$883.61
Atlanta, GAUnavailable$1,001.87
Austin, TXUnavailable$979.49
Bakersfield, CAUnavailable$970.67
Baltimore area, MDUnavailable$1,029.21
Beaumont, TXUnavailable$941.75
Brazoria, TXUnavailable$953.16

45540 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
45540 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 45540 rate is calculated

Each of 45540’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 · 45540

RVUs × geographic indexes × conversion factor

Office or facility?

Work17.67

17.67 RVUs× 1.000 GPCI

Practice expense8.32

8.32 RVUs× 1.000 GPCI

Malpractice3.18

3.18 RVUs× 1.000 GPCI

Adjusted RVUs

29.1700

Conversion factor

$33.4009

Medicare rate

$974.30

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

Payment rules and modifiers for 45540

45540 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45540

Rectal prolapse repair, abdominal 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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 45540

Rectal prolapse repair, abdominal 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

45540 without 51 · national facility

$974.30

Rectal prolapse repair, abdominal approach

45540-51 · Second procedure: 50%

$487.15

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

45540 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 45540

    Rectal prolapse repair, abdominal approach17.67 wRVU

    Not priced

  • 45541

    Prolapse repair, perineal approach14.48 wRVU

    Not priced

  • 45550

    Rectal repair, with sigmoid resection24.18 wRVU

    Not priced

  • 45400

    Rectopexy, laparoscopic, without resection18.95 wRVU

    Not priced

  • 45402

    Laparoscopic rectopexy, with sigmoid resection25.85 wRVU

    Not priced

How to choose

45541Prolapse repairPerineal approach
Choose 45541 for a perineal repair; choose 45540 for an abdominal repair.
45550Rectal repairWith sigmoid resection
45550 includes sigmoid resection with the abdominal prolapse repair. 45540 describes the repair without that resection.
45400RectopexyLaparoscopic, without resection
45400 describes laparoscopic rectopexy without resection. 45540 describes the abdominal approach represented by its code.
45402Laparoscopic rectopexyWith sigmoid resection
45402 describes laparoscopic rectopexy with resection; 45540 is the abdominal repair code without sigmoid resection.

Codes related to 45540

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

Codes related to 45540
CodeHow it relatesNational office range
Same family
45541Prolapse repair, perineal approachRectal prolapse repair through a perineal rather than abdominal approach.No office rate
45550Rectal repair, with sigmoid resectionAbdominal prolapse repair that includes sigmoid resection.No office rate
Used instead
45400Rectopexy, laparoscopic, without resectionLaparoscopic rectopexy without resection.No office rate
45402Laparoscopic rectopexy, with sigmoid resectionLaparoscopic rectopexy with resection.No office rate

45540 billing questions

How is 45540 distinguished from 45550?

45540 describes abdominal repair without sigmoid resection. When the abdominal prolapse repair includes sigmoid resection, use 45550.

When should 45541 be reported instead?

45541 describes repair through a perineal approach. Use 45540 when the surgeon repairs the prolapse through an abdominal approach.

Does 45540 describe laparoscopic rectopexy?

No. Laparoscopic rectopexy is described by 45400 without resection or 45402 with resection; 45540 is for the abdominal approach represented by that code.

What operative documentation supports 45540?

Document the rectal prolapse, the abdominal approach, and the repair performed. State whether sigmoid resection was performed so the applicable repair code can be selected.

How does the global period affect postoperative billing?

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

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 45540PPRRVU2026_Oct_nonQPP.csv, line 5,544 (RVU26D)

Open CMS sourceHow we calculate rates

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