CPT code 45999: Rectal procedure, no listed code2026 Medicare rate & RVUs

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

What 45999 covers

This code identifies a procedure involving the rectum when no listed CPT procedure code accurately represents the work. Colorectal and general surgeons may report it for a procedural service that does not match a defined rectal procedure; it is not a substitute for a listed code that describes the service. Listed procedures include reduction of rectal prolapse, dilation of the anal sphincter or a rectal narrowing, and removal of a rectal obstruction. The operative documentation should explain the condition treated and the technique and work performed, allowing the unlisted service to be evaluated.

For Medicare physician fee schedule purposes, 45999 has status C: CMS publishes no national payment, and the Medicare Administrative Contractor sets payment for each claim. The contractor also sets the global period. When procedures are performed in the same session, Medicare applies its standard multiple procedure reduction: the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 45999 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

45999 rates by state

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

How the 45999 rate is calculated

Each of 45999’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.

Payment rules and modifiers for 45999

The CMS indicators that decide how 45999 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

45999 compared with similar codes

How to choose

45900Prolapse reductionUnder anesthesia

45900 describes reduction of rectal prolapse. Use 45999 only when the rectal procedure performed is not accurately represented by that or another listed code.

45910Rectal dilationUnder anesthesia

45910 describes dilation of a rectal narrowing. It is the specific choice when that is the procedure performed; 45999 is for an otherwise unlisted rectal procedure.

45915Rectal obstruction removalUnder anesthesia

45915 describes removal of a rectal obstruction. Choose 45999 only when the service is not that defined procedure and has no more specific CPT code.

45990Anorectal examDiagnostic, under anesthesia

45990 describes a diagnostic anorectal examination. Choose based on the service performed, not simply the anorectal location; 45999 is for a rectal procedure without a specific listed code.

Codes related to 45999

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

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

Open CMS sourceHow we calculate rates