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Billing code 45112: Rectal removalMedicare rate & RVUs

Reports complete rectal removal through an abdominal and perineal operation, with colostomy and pelvic lymph node dissection, commonly for rectal cancer.

CMS RVU26DEffective Oct 1, 2026109 payment localities38 Medicare services in 2024

Medicare pays $1,640.65 for 45112 nationally in a facility.

Medicare rate · 45112

Rectal removal

Swap in your local Medicare rate.

Work RVUs
32.35
Total RVUs
49.12
Global days
090

National rate · 2026

$1,640.65

Facility setting, before claim adjustments.

See every locality for 45112 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 45112 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 45112 covers

This operation removes the rectum through abdominal and perineal access, creates a colostomy, and includes pelvic lymph node dissection. Colorectal or general surgeons commonly perform it in a hospital for rectal cancer requiring this extent of resection. The operative report should establish the complete rectal resection, the colostomy, and the lymph node dissection; a limited rectal resection or a procedure using a different reconstruction belongs to a different code pathway.

CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted. Modifier 50 is inappropriate for this operation.

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 45112 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

45112 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,522.54
Alaska*Unavailable$2,137.32
ArizonaUnavailable$1,605.70
ArkansasUnavailable$1,508.13
AtlantaUnavailable$1,681.65
AustinUnavailable$1,648.53
BakersfieldUnavailable$1,639.15
Baltimore/Surr. CntysUnavailable$1,724.36
BeaumontUnavailable$1,593.20
BrazoriaUnavailable$1,611.41

45112 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
45112 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 45112 rate is calculated

Each of 45112’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 · 45112

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 32.35Practice expense 12.11Malpractice 4.66

49.1200 adjusted RVUs×$33.4009 conversion factor=$1,640.65

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 45112

45112 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45112

Rectal removal

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 · 45112

Rectal removal

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

45112 without 51 · national facility

$1,640.65

Rectal removal

45112-51 · Second procedure: 50%

$820.33

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

45112 compared with similar codes

Compare codes

45112 vs 45110 vs 45111 vs 45119 vs 45121: national Medicare rates

Swap in your local Medicare rate.

  • 45112
    Rectal removal · 32.35 wRVU
    —
  • 45110
    Rectal resection · 29.99 wRVU
    —
  • 45111
    Partial proctectomy · 17.56 wRVU
    —
  • 45119
    Proctectomy · 32.64 wRVU
    —
  • 45121
    Proctocolectomy · 28.35 wRVU
    —

How to choose

45110Rectal resection
Both describe complete rectal removal with colostomy, but 45112 includes pelvic lymph node dissection. Choose 45110 when that dissection is not performed.
45111Partial proctectomy
45111 describes partial rectal removal with anastomosis. 45112 is for complete removal with colostomy and pelvic lymph node dissection.
45119Proctectomy
45119 uses an ileal reservoir reconstruction; 45112 includes colostomy creation and pelvic lymph node dissection.
45121Proctocolectomy
45121 includes removal of colon as well as rectum. 45112 describes complete rectal removal with colostomy and pelvic lymph node dissection.

Codes related to 45112

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

Codes related to 45112
CodeHow it relatesNational office range
Same family
45110Rectal resectionComplete rectal removal with colostomy, without the pelvic lymph node dissection included in 45112.No office rate
45111Partial proctectomyA partial rectal resection with anastomosis, rather than complete rectal removal.No office rate
Used instead
45119ProctectomyComplete rectal removal with an ileal reservoir rather than the colostomy approach in 45112.No office rate
45121ProctocolectomyA more extensive resection that includes colon as well as rectum.No office rate

45112 billing questions

How does 45112 differ from 45110?

45112 includes pelvic lymph node dissection with the complete rectal resection and colostomy. Use 45110 when that additional dissection is not performed.

Can 45112 be reported for a partial rectal resection?

No. This code represents complete rectal removal; partial resections with anastomosis are represented by other codes, such as 45111.

What operative documentation supports 45112?

The report should describe complete rectal removal, colostomy creation, and pelvic lymph node dissection, along with the abdominal and perineal operative work.

Can an assistant surgeon be paid for 45112?

CMS permits assistant-at-surgery payment for this code. Co-surgeon payment requires supporting documentation.

How does the 90-day global period affect postoperative billing?

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

Should modifier 50 be used?

No. Modifier 50 is inappropriate for this operation.

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 45112PPRRVU2026_Oct_nonQPP.csv, line 5,468 (RVU26D)

Open CMS sourceHow we calculate rates

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