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Billing code 45160: Rectal lesion excisionMedicare rate & RVUs

Reports surgical removal of a localized rectal lesion, such as an adenoma, when the procedure removes the lesion rather than taking a diagnostic sample.

CMS RVU26DEffective Oct 1, 2026109 payment localities12 Medicare services in 2024

Medicare pays $976.31 for 45160 nationally in a facility.

Medicare rate · 45160

Rectal lesion excision

Swap in your local Medicare rate.

Work RVUs
15.92
Total RVUs
29.23
Global days
090

National rate · 2026

$976.31

Facility setting, before claim adjustments.

See every locality for 45160 → · 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 45160 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 45160 covers

A surgeon removes a localized lesion from the rectum, rather than taking tissue only for diagnosis. A colorectal surgeon or other surgeon performing rectal operations typically performs the service in an operating room, often in a facility setting. A rectal adenoma is one example; the operative plan and documented procedure determine whether this excision code or a more specific rectal tumor procedure applies.

Report the service when the operative note supports excision of the rectal lesion. Documentation should identify the lesion and describe the removal performed, so the service can be distinguished from biopsy, tumor destruction, or removal of part or all of the rectum. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

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 45160 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

45160 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$876.87
Alaska*Unavailable$1,198.11
ArizonaUnavailable$946.49
ArkansasUnavailable$864.79
AtlantaUnavailable$1,011.28
AustinUnavailable$978.74
BakersfieldUnavailable$959.96
Baltimore/Surr. CntysUnavailable$1,040.55
BeaumontUnavailable$938.99
BrazoriaUnavailable$946.61

45160 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
45160 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 45160 rate is calculated

Each of 45160’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 · 45160

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 15.92Practice expense 9.06Malpractice 4.25

29.2300 adjusted RVUs×$33.4009 conversion factor=$976.31

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

Payment rules and modifiers for 45160

45160 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45160

Rectal lesion excision

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 · 45160

Rectal lesion excision

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

45160 without 51 · national facility

$976.31

Rectal lesion excision

45160-51 · Second procedure: 50%

$488.16

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

45160 compared with similar codes

Compare codes

45160 vs 45100 vs 45171 vs 45172 vs 45190: national Medicare rates

Swap in your local Medicare rate.

  • 45160
    Rectal lesion excision · 15.92 wRVU
    —
  • 45100
    Rectal biopsy · 3.94 wRVU
    —
  • 45171
    Rectal tumor excision · 7.93 wRVU
    —
  • 45172
    Rectal tumor excision · 11.83 wRVU
    —
  • 45190
    Rectal tumor destruction · 10.16 wRVU
    —

How to choose

45100Rectal biopsy
45100 is for obtaining a rectal tissue sample; 45160 represents removal of a localized lesion.
45171Rectal tumor excision
45171 identifies transanal rectal tumor excision with a partial-thickness procedure. Select it when that specific procedure is documented.
45172Rectal tumor excision
45172 identifies transanal rectal tumor excision with a full-thickness procedure. The operative report must support that distinction.
45190Rectal tumor destruction
45190 is for destruction of a rectal tumor; 45160 is used when the lesion is excised.

Codes related to 45160

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

Codes related to 45160
CodeHow it relatesNational office range
Used instead
45100Rectal biopsyRectal biopsy for tissue sampling when the service is diagnostic rather than lesion excision.No office rate
45171Rectal tumor excisionTransanal rectal tumor excision when the documented procedure is partial thickness.No office rate
45172Rectal tumor excisionTransanal rectal tumor excision when the documented procedure is full thickness.No office rate
45190Rectal tumor destructionRectal tumor destruction when the lesion is destroyed rather than excised.No office rate
45111Partial proctectomyPartial rectal removal for an operation involving resection of rectum rather than local lesion excision.No office rate

45160 billing questions

How does this differ from rectal biopsy code 45100?

Code 45160 represents excision of a lesion; 45100 is for obtaining a rectal tissue sample for diagnosis. Choose based on the procedure documented, not simply the lesion’s suspected diagnosis.

When would 45171 or 45172 be a better fit?

Those codes describe transanal rectal tumor excision with partial- or full-thickness distinctions. Use them when the operative documentation supports their specific procedure and depth, rather than relying on the general lesion-excision description.

What postoperative care is included?

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

Can modifier 50 be reported for lesions on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 does not apply.

How are other procedures in the same session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

May 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.

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 45160PPRRVU2026_Oct_nonQPP.csv, line 5,481 (RVU26D)

Open CMS sourceHow we calculate rates

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