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Billing code 45190: Rectal tumor destructionMedicare rate & RVUs

Reports destruction of a rectal tumor using a method such as electrosurgery or cryosurgery, rather than removal by excision.

CMS RVU26DEffective Oct 1, 2026109 payment localities296 Medicare services in 2024

Medicare pays $672.36 for 45190 nationally in a facility.

Medicare rate · 45190

Rectal tumor destruction

Swap in your local Medicare rate.

Work RVUs
10.16
Total RVUs
20.13
Global days
090

National rate · 2026

$672.36

Facility setting, before claim adjustments.

See every locality for 45190 → · 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 45190 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 45190 covers

A surgeon destroys a tumor located in the rectum, using a method such as electrosurgery or cryosurgery. The service is typically performed by a colorectal or general surgeon in an operating room or other procedural setting. It describes treatment by destruction, not removal of the tumor through an excision approach.

Report the service when the operative documentation identifies the rectal tumor and the destruction technique. The 90-day global period includes 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 multiple-procedure reduction. Modifier 50 is inappropriate for this rectal service. Medicare does not pay an assistant at surgery; co-surgeons are paid only with 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 45190 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

45190 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$615.77
Alaska*Unavailable$838.79
ArizonaUnavailable$656.56
ArkansasUnavailable$608.75
AtlantaUnavailable$687.67
AustinUnavailable$684.02
BakersfieldUnavailable$687.19
Baltimore/Surr. CntysUnavailable$710.04
BeaumontUnavailable$643.31
BrazoriaUnavailable$661.86

45190 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
45190 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 45190 rate is calculated

Each of 45190’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 · 45190

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 10.16Practice expense 8.52Malpractice 1.45

20.1300 adjusted RVUs×$33.4009 conversion factor=$672.36

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

Payment rules and modifiers for 45190

45190 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45190

Rectal tumor destruction

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)1Not paid (statutory restriction).
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 · 45190

Rectal tumor destruction

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

45190 without 51 · national facility

$672.36

Rectal tumor destruction

45190-51 · Second procedure: 50%

$336.18

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

45190 compared with similar codes

Compare codes

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

Swap in your local Medicare rate.

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

How to choose

45100Rectal biopsy
45100 is rectal biopsy for tissue sampling. Choose 45190 when the service performed is destruction of the tumor.
45160Rectal lesion excision
45160 describes transanal excision of a rectal lesion, including muscularis propria; 45190 describes destruction rather than excision.
45171Rectal tumor excision
45171 is transanal partial-thickness excision of a rectal tumor. Use 45190 for destruction, not partial-thickness removal.
45172Rectal tumor excision
45172 is transanal full-thickness excision of a rectal tumor. Use 45190 when the tumor is destroyed instead of excised.

Codes related to 45190

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

Codes related to 45190
CodeHow it relatesNational office range
Used instead
45160Rectal lesion excisionTransanal excision of a rectal lesion is an excisional approach rather than tumor destruction.No office rate
45171Rectal tumor excisionTransanal partial-thickness tumor excision removes tissue instead of destroying the tumor.No office rate
45172Rectal tumor excisionTransanal full-thickness tumor excision removes the tumor rather than destroying it.No office rate

45190 billing questions

How is destruction different from transanal excision?

Use 45190 when the tumor is destroyed. Codes 45171 and 45172 describe transanal excision, with the distinction based on partial- versus full-thickness removal.

Can a rectal biopsy be reported instead of 45190?

45100 describes biopsy for tissue sampling. It is not a substitute for a documented procedure that destroys the tumor.

Should modifier 50 be appended?

No. Modifier 50 is inappropriate for this rectal tumor service.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

What documentation supports 45190?

Document the rectal tumor treated and the method used to destroy it. The record should distinguish destruction from biopsy or excision.

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 45190PPRRVU2026_Oct_nonQPP.csv, line 5,484 (RVU26D)

Open CMS sourceHow we calculate rates

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