CPT code 45999: Rectal procedure, no listed code2026 Medicare rate & RVUs in Massachusetts
Reports a rectal procedure without a specific CPT code when a surgeon performs work that cannot be accurately represented by a listed procedure.
CMS doesn’t publish an office rate for 45999 in Massachusetts.
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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On this page 9 sections
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 in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
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.
How the rate is built · 45999
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45999
The CMS indicators that decide how 45999 is paid alongside other services.
CMS payment indicators · 45999
Rectal procedure, no listed code
| Rule | CMS value | What it means |
|---|---|---|
| Global period | YYY | The Medicare contractor sets the global period. |
| 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
45999 without 51 · national facility
$0.00
Rectal procedure, no listed code
45999-51 · Second procedure: 50%
$0.00
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%).
45999 compared with similar codes
Compare codes · National
5 codes, side by side
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.
45999 billing questions
When should 45999 be used instead of a listed rectal procedure code?
Use it when no specific CPT code accurately describes the rectal procedure performed. Rectal prolapse reduction or removal of a rectal obstruction has a listed code when that is the service provided.
What documentation should accompany a claim for 45999?
Describe the condition treated, the rectal anatomy involved, the technique, and the work performed. The narrative should explain why a specific listed procedure code does not describe the service.
How does Medicare price 45999?
Its physician fee schedule status is C, so CMS publishes no national payment. The Medicare Administrative Contractor sets payment for each claim.
Who sets the global period for 45999?
The Medicare contractor sets the global period.
How is 45999 treated when other procedures are done 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%.
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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