CPT code 45990: Anorectal exam, diagnostic, under anesthesia2026 Medicare rate & RVUs in Maryland
A surgeon examines the anal canal and distal rectum under anesthesia when pain, spasm, or limited access prevents an adequate diagnostic office examination.
CMS doesn’t publish an office rate for 45990 in Maryland.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 45990 covers
This service is a diagnostic examination of the anal canal and distal rectum performed under anesthesia, typically by a colorectal or general surgeon in an operating room or other procedural setting. It is useful when pain, sphincter spasm, or inability to tolerate positioning prevents a reliable office assessment—for example, when evaluating persistent anorectal pain, bleeding, or a suspected lesion. The code represents the diagnostic examination, not treatment of a prolapse, narrowing, or obstruction.
Report it when the record supports why an examination under anesthesia was needed, what areas and findings were assessed, and the diagnostic purpose. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery, co-surgeon, and team-surgery payment requires documentation supporting medical necessity.
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 45990 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $105.37 |
| Rest of Maryland | Unavailable | $99.51 |
| Washington, DC area | Unavailable | $109.20 |
How the 45990 rate is calculated
Each of 45990’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 · 45990
RVUs × geographic indexes × conversion factor
Work1.76
1.76 RVUs× 1.000 GPCI
Practice expense0.87
0.87 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
2.9800
Conversion factor
$33.4009
Medicare rate
$99.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45990
The CMS indicators that decide how 45990 is paid alongside other services.
CMS payment indicators · 45990
Anorectal exam, diagnostic, under anesthesia
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45990 without 51 · national facility
$99.53
Anorectal exam, diagnostic, under anesthesia
45990-51 · Second procedure: 50%
$49.77
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%).
45990 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46600Diagnostic anoscopyStandard visualization, optional washing
- 46600 is diagnostic anoscopy without the examination-under-anesthesia service. Choose 45990 when anesthesia is needed to complete a reliable anorectal examination.
- 45905Anal dilationAnal sphincter
- 45905 is an anal sphincter dilation procedure. 45990 is diagnostic and does not represent dilation.
- 45910Rectal dilationUnder anesthesia
- 45910 treats rectal narrowing by dilation; 45990 documents a diagnostic anorectal examination rather than treatment of a stricture.
45990 billing questions
When is 45990 more appropriate than office anoscopy?
Use 45990 when an adequate diagnostic anorectal examination requires anesthesia, such as when pain or spasm prevents a reliable office examination. An office anoscopy is appropriate when the patient can tolerate that examination.
Does 45990 describe treatment of a finding?
No. It describes a diagnostic examination. A service that treats a prolapse, anal narrowing, or rectal obstruction has its own procedure code and must be supported by the operative record.
What documentation supports reporting 45990?
Document the reason an examination under anesthesia was needed, the diagnostic purpose, the areas examined, and the findings. The record should make clear why an office examination was inadequate.
How is same-session multiple-procedure payment handled?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment also require supporting documentation.
What care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care.
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
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