No office rate
This code is for complete rectal removal; 45126 is for complete pelvic exenteration involving multiple pelvic organs for malignancy.
On this page
CMS RVU26D · Effective 2026-10-01
45126 Pelvic exenteration Medicare reimbursement rates
Reports complete pelvic exenteration for malignancy, an extensive operation removing multiple pelvic organs when cancer involves or recurs across pelvic structures. Compare 45126 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 45126?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 45126 pays more and less
Pelvic oncology surgery
About 45126: Complete pelvic exenteration for malignancy
Reports complete pelvic exenteration for malignancy, an extensive operation removing multiple pelvic organs when cancer involves or recurs across pelvic structures.
Pelvic exenteration is an extensive operation for locally advanced or recurrent pelvic cancer that requires removal of multiple pelvic organs as part of one surgical plan. The organs removed depend on the tumor’s location and extent; the procedure may involve colorectal, gynecologic oncology, and urologic surgeons. It is typically performed in a hospital operating room, not an office setting.
Select this code when the operative report supports complete exenteration for malignancy, rather than removal of the rectum alone or a partial rectal resection. Document the cancer indication, structures removed, and extent of the operation. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard multiple-procedure reduction. Modifier 50 is not appropriate for this operation. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45126
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU47.87 · 64%
- Practice expense (office) RVU18.16 · 24%
- Malpractice RVU8.30 · 11%
107
Medicare services in 2024 · #4830 by national volume
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.
45126 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
45111 describes partial rectal removal. Choose 45126 when the documented operation is complete exenteration rather than a limited rectal resection.
No office rate
45121 covers removal of the rectum and colon. It is not the exenteration code unless the operative plan and documentation support complete pelvic exenteration.
See how rates vary across the country
45126 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 45126 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $2286.55 |
| Alaska* | Office Unavailable | Facility $3197.09 |
| Arizona | Office Unavailable | Facility $2423.96 |
| Arkansas | Office Unavailable | Facility $2262.71 |
| Atlanta | Office Unavailable | Facility $2552.91 |
| Austin | Office Unavailable | Facility $2489.46 |
| Bakersfield | Office Unavailable | Facility $2462.90 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $2618.25 |
| Beaumont | Office Unavailable | Facility $2408.42 |
| Brazoria | Office Unavailable | Facility $2429.03 |
| Chicago | Office Unavailable | Facility $2855.92 |
| Chico | Office Unavailable | Facility $2439.47 |
| Colorado | Office Unavailable | Facility $2479.98 |
| Connecticut | Office Unavailable | Facility $2619.59 |
| Dallas | Office Unavailable | Facility $2455.29 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $2708.32 |
| Delaware | Office Unavailable | Facility $2455.40 |
| Detroit | Office Unavailable | Facility $2651.64 |
| East St. Louis | Office Unavailable | Facility $2715.27 |
| El Centro | Office Unavailable | Facility $2440.85 |
| Fort Lauderdale | Office Unavailable | Facility $2714.57 |
| Fort Worth | Office Unavailable | Facility $2452.82 |
| Fresno | Office Unavailable | Facility $2439.47 |
| Galveston | Office Unavailable | Facility $2443.55 |
| Hanford-Corcoran | Office Unavailable | Facility $2439.47 |
| Hawaii, Guam | Office Unavailable | Facility $2449.07 |
| Houston | Office Unavailable | Facility $2595.47 |
| Idaho | Office Unavailable | Facility $2288.07 |
| Indiana | Office Unavailable | Facility $2295.92 |
| Iowa | Office Unavailable | Facility $2263.96 |
| Kansas | Office Unavailable | Facility $2286.95 |
| Kentucky | Office Unavailable | Facility $2391.80 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $2566.10 |
| Madera | Office Unavailable | Facility $2439.47 |
| Manhattan | Office Unavailable | Facility $2845.74 |
| Merced | Office Unavailable | Facility $2439.47 |
| Metropolitan Boston | Office Unavailable | Facility $2635.42 |
| Metropolitan Kansas City | Office Unavailable | Facility $2439.31 |
| Metropolitan Philadelphia | Office Unavailable | Facility $2589.84 |
| Metropolitan St. Louis | Office Unavailable | Facility $2454.13 |
| Miami | Office Unavailable | Facility $2931.44 |
| Minnesota | Office Unavailable | Facility $2305.11 |
| Mississippi | Office Unavailable | Facility $2326.02 |
| Modesto | Office Unavailable | Facility $2439.47 |
| Montana** | Office Unavailable | Facility $2482.13 |
| Napa | Office Unavailable | Facility $2639.91 |
| Nebraska | Office Unavailable | Facility $2263.55 |
| Nevada** | Office Unavailable | Facility $2437.00 |
| New Hampshire | Office Unavailable | Facility $2472.90 |
| New Mexico | Office Unavailable | Facility $2488.07 |
| New Orleans | Office Unavailable | Facility $2484.60 |
| North Carolina | Office Unavailable | Facility $2341.97 |
| North Dakota** | Office Unavailable | Facility $2318.02 |
| Northern Nj | Office Unavailable | Facility $2699.32 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $2937.24 |
| Ohio | Office Unavailable | Facility $2432.14 |
| Oklahoma | Office Unavailable | Facility $2355.97 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $2533.34 |
| Portland | Office Unavailable | Facility $2504.63 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $2670.48 |
| Puerto Rico | Office Unavailable | Facility $2485.20 |
| Queens | Office Unavailable | Facility $2817.95 |
| Redding | Office Unavailable | Facility $2439.47 |
| Rest Of California | Office Unavailable | Facility $2439.47 |
| Rest Of Florida | Office Unavailable | Facility $2595.45 |
| Rest Of Georgia | Office Unavailable | Facility $2470.41 |
| Rest Of Illinois | Office Unavailable | Facility $2586.00 |
| Rest Of Louisiana | Office Unavailable | Facility $2401.29 |
| Rest Of Maine | Office Unavailable | Facility $2329.37 |
| Rest Of Maryland | Office Unavailable | Facility $2483.22 |
| Rest Of Massachusetts | Office Unavailable | Facility $2484.14 |
| Rest Of Michigan | Office Unavailable | Facility $2465.68 |
| Rest Of Missouri | Office Unavailable | Facility $2391.78 |
| Rest Of New Jersey | Office Unavailable | Facility $2629.34 |
| Rest Of New York | Office Unavailable | Facility $2370.02 |
| Rest Of Oregon | Office Unavailable | Facility $2397.93 |
| Rest Of Pennsylvania | Office Unavailable | Facility $2417.70 |
| Rest Of Texas | Office Unavailable | Facility $2424.86 |
| Rest Of Washington | Office Unavailable | Facility $2469.36 |
| Rhode Island | Office Unavailable | Facility $2503.14 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $2528.95 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $2510.49 |
| Salinas | Office Unavailable | Facility $2500.06 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $2522.57 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $2733.29 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $2723.87 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $2798.03 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $2759.50 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $2465.55 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $2518.04 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $2499.51 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $2540.32 |
| Seattle (King Cnty) | Office Unavailable | Facility $2649.59 |
| South Carolina | Office Unavailable | Facility $2395.01 |
| South Dakota** | Office Unavailable | Facility $2298.61 |
| Southern Maine | Office Unavailable | Facility $2374.93 |
| Stockton | Office Unavailable | Facility $2439.47 |
| Suburban Chicago | Office Unavailable | Facility $2724.28 |
| Tennessee | Office Unavailable | Facility $2299.14 |
| Utah | Office Unavailable | Facility $2418.02 |
| Vallejo | Office Unavailable | Facility $2626.33 |
| Vermont | Office Unavailable | Facility $2339.67 |
| Virgin Islands | Office Unavailable | Facility $2485.20 |
| Virginia | Office Unavailable | Facility $2390.87 |
| Visalia | Office Unavailable | Facility $2439.47 |
| West Virginia | Office Unavailable | Facility $2522.71 |
| Wisconsin | Office Unavailable | Facility $2265.37 |
| Wyoming** | Office Unavailable | Facility $2410.61 |
| Yuba City | Office Unavailable | Facility $2439.47 |
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45126 billing questions
How is this different from a proctectomy?
Exenteration involves complete removal of multiple pelvic organs for malignancy. A proctectomy is selected when the planned operation removes the rectum without the broader pelvic-organ resection.
What documentation supports reporting this code?
The operative report should establish the malignant indication, the organs removed, and that the procedure was a complete pelvic exenteration rather than an isolated rectal resection.
Are related postoperative visits included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures performed in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be appended?
No. This is not a paired-side operation, so modifier 50 is inappropriate.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,47345120,,Removal of rectum,A,,25.74,12.24,NA,12.24,,6.87,44.85,44.85,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47445121,,Removal of rectum and colon,A,,28.35,12.87,NA,12.87,,7.59,48.81,48.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47545123,,Partial proctectomy,A,,18.39,9.25,NA,9.25,,3.28,30.92,30.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47645126,,Pelvic exenteration,A,,47.87,18.16,NA,18.16,,8.30,74.33,74.33,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47745130,,Excision of rectal prolapse,A,,18.04,8.80,NA,8.80,,3.24,30.08,30.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47845135,,Excision of rectal prolapse,A,,21.80,10.88,NA,10.88,,3.13,35.81,35.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47945136,,Excise ileoanal reservior,A,,30.05,14.58,NA,14.58,,4.32,48.95,48.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00