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CPT code 45550: Rectal repair, with sigmoid resection2026 Medicare rate & RVUs

Reports an abdominal rectal repair performed with sigmoid colon resection, commonly during operative treatment of rectal prolapse when both procedures are part of the same operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities98 Medicare services in 2024

Medicare pays $1,352.40 for 45550 nationally in a facility.

Medicare rate · 45550

Rectal repair, with sigmoid resection

Office or facility?

Work RVUs
24.18
Total RVUs
40.49
Global days
090

National rate · 2026

$1,352.40

Facility setting, before claim adjustments.

See every locality for 45550 →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 45550 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 45550 covers

A colorectal or general surgeon performs this abdominal operation to repair or support the rectum while removing a segment of sigmoid colon. A common setting is surgery for rectal prolapse when the surgeon also resects sigmoid colon, such as when the sigmoid is redundant. The operative report should make clear that both the rectal repair and sigmoid resection were performed; the code is not selected just because a patient has rectal prolapse or undergoes a sigmoid resection alone.

Report the service for the combined work documented in the operative note, including the abdominal approach, rectal repair, and sigmoid resection. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this operation. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery 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 45550 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

45550 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,237.04
AlaskaUnavailable$1,713.00
ArizonaUnavailable$1,318.23
ArkansasUnavailable$1,222.97
Atlanta, GAUnavailable$1,391.84
Austin, TXUnavailable$1,359.30
Bakersfield, CAUnavailable$1,345.55
Baltimore area, MDUnavailable$1,430.18
Beaumont, TXUnavailable$1,306.28
Brazoria, TXUnavailable$1,321.68

45550 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
45550 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 45550 rate is calculated

Each of 45550’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 · 45550

RVUs × geographic indexes × conversion factor

Office or facility?

Work24.18

24.18 RVUs× 1.000 GPCI

Practice expense11.73

11.73 RVUs× 1.000 GPCI

Malpractice4.58

4.58 RVUs× 1.000 GPCI

Adjusted RVUs

40.4900

Conversion factor

$33.4009

Medicare rate

$1,352.40

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

Payment rules and modifiers for 45550

45550 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45550

Rectal repair, with sigmoid resection

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 · 45550

Rectal repair, with sigmoid resection

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

45550 without 51 · national facility

$1,352.40

Rectal repair, with sigmoid resection

45550-51 · Second procedure: 50%

$676.20

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

45550 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 45550

    Rectal repair, with sigmoid resection24.18 wRVU

    Not priced

  • 45505

    Rectal repair, transanal approach8.15 wRVU

    Not priced

  • 45540

    Rectal prolapse repair, abdominal approach17.67 wRVU

    Not priced

  • 45541

    Prolapse repair, perineal approach14.48 wRVU

    Not priced

  • 45520

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

    $168.67

How to choose

45505Rectal repairTransanal approach
45505 covers rectal repair by a transsacral or abdominal approach without the sigmoid resection included in 45550.
45540Rectal prolapse repairAbdominal approach
Choose 45540 for abdominal rectal prolapse repair without sigmoid resection; 45550 applies when the abdominal repair and sigmoid resection are both performed.
45541Prolapse repairPerineal approach
45541 is used for rectal prolapse repair through a perineal approach. 45550 describes an abdominal operation that includes sigmoid resection.
45520Rectal prolapse treatmentLocal treatment, any method
45520 is an external-approach prolapse treatment, unlike the abdominal rectal repair with sigmoid resection reported with 45550.

Codes related to 45550

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

Codes related to 45550
CodeHow it relatesNational office range
Same family
45505Rectal repair, transanal approachRectal repair by a transsacral or abdominal approach without the sigmoid resection described here.No office rate
45500Rectal injury repair, injury-related proctoplastyRectal repair through a perineal approach, rather than the abdominal combined operation.No office rate
Used instead
45540Rectal prolapse repair, abdominal approachAbdominal repair for rectal prolapse when sigmoid resection is not part of the procedure.No office rate
45541Prolapse repair, perineal approachRectal prolapse repair performed through a perineal approach.No office rate
45520Rectal prolapse treatment, local treatment, any methodExternal-approach treatment of rectal prolapse rather than abdominal repair with sigmoid resection.$146.63–$235.12

45550 billing questions

How does this differ from 45540?

45550 includes sigmoid resection with the abdominal rectal repair. 45540 is an abdominal repair for rectal prolapse without that sigmoid resection component.

When would 45541 be considered instead?

45541 describes rectal prolapse repair through a perineal approach. Use 45550 when the documented operation uses an abdominal approach and includes sigmoid resection.

Can the sigmoid resection and rectal repair be reported separately?

This code represents the combined rectal repair and sigmoid resection service. Do not separately report another code for the same work; evaluate any distinct additional procedure on its own documentation.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this rectal operation, and a bilateral adjustment does not apply.

What operative documentation supports 45550?

Document the abdominal approach, the rectal repair or support performed, and the sigmoid colon resection. The note should distinguish this combined operation from prolapse repair without sigmoid resection.

How are assistant and co-surgeon claims handled?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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 45550PPRRVU2026_Oct_nonQPP.csv, line 5,547 (RVU26D)

Open CMS sourceHow we calculate rates

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