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Billing code 45397: ProctectomyMedicare rate & RVUs

Reports laparoscopic complete proctectomy with creation of an ileal pouch and connection to the anus, with or without a diverting ileostomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities131 Medicare services in 2024

Medicare pays $1,941.93 for 45397 nationally in a facility.

Medicare rate · 45397

Proctectomy

Swap in your local Medicare rate.

Work RVUs
35.59
Total RVUs
58.14
Global days
090

National rate · 2026

$1,941.93

Facility setting, before claim adjustments.

See every locality for 45397 → · 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 45397 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 45397 covers

A colorectal surgeon uses a laparoscopic approach to remove the rectum and create an ileal reservoir, typically an S- or J-shaped pouch, connected to the anus. This restorative operation may be performed for conditions such as ulcerative colitis or familial adenomatous polyposis. A diverting ileostomy may also be created to protect the pouch connection; it is included in the service when performed.

Select this code when the operative report supports laparoscopic complete proctectomy, ileal pouch construction, and ileoanal anastomosis. The pouch and anastomosis distinguish it from laparoscopic proctectomy with colostomy. The service has 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 others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this unpaired anatomy.

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 45397 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

45397 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,784.20
Alaska*Unavailable$2,479.50
ArizonaUnavailable$1,895.33
ArkansasUnavailable$1,764.95
AtlantaUnavailable$1,995.61
AustinUnavailable$1,952.60
BakersfieldUnavailable$1,936.62
Baltimore/Surr. CntysUnavailable$2,049.67
BeaumontUnavailable$1,878.05
BrazoriaUnavailable$1,901.25

45397 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
45397 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 45397 rate is calculated

Each of 45397’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 · 45397

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 35.59Practice expense 16.39Malpractice 6.16

58.1400 adjusted RVUs×$33.4009 conversion factor=$1,941.93

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

Payment rules and modifiers for 45397

45397 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45397

Proctectomy

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 · 45397

Proctectomy

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

45397 without 51 · national facility

$1,941.93

Proctectomy

45397-51 · Second procedure: 50%

$970.97

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

45397 compared with similar codes

Compare codes

45397 vs 45395 vs 45113 vs 44212: national Medicare rates

Swap in your local Medicare rate.

  • 45397
    Proctectomy · 35.59 wRVU
    —
  • 45395
    Rectal resection · 32.18 wRVU
    —
  • 45113
    Partial proctectomy · 32.39 wRVU
    —
  • 44212
    Proctocolectomy · 33.72 wRVU
    —

How to choose

45395Rectal resection
Choose 45397 when the laparoscopic operation creates an ileal pouch with an ileoanal connection. Choose 45395 for laparoscopic proctectomy with colostomy instead.
45113Partial proctectomy
45113 describes the open approach to complete proctectomy with ileal pouch reconstruction; 45397 describes the laparoscopic approach.
44212Proctocolectomy
44212 is for laparoscopic total colectomy with proctectomy and ileal pouch reconstruction. Use 45397 when the documented procedure is proctectomy with pouch creation rather than total colectomy.

Codes related to 45397

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

Codes related to 45397
CodeHow it relatesNational office range
Used instead
45395Rectal resectionLaparoscopic proctectomy with colostomy rather than ileal pouch reconstruction.No office rate
45113Partial proctectomyOpen approach for complete proctectomy with ileal reservoir and ileoanal anastomosis.No office rate
44212ProctocolectomyApplies when the operation includes total colectomy with proctectomy and ileal pouch reconstruction.No office rate
45110Rectal resectionOpen complete proctectomy with colostomy, rather than laparoscopic pouch reconstruction.No office rate

45397 billing questions

How does this differ from 45395?

45397 includes creation of an ileal pouch and an ileoanal connection. 45395 describes laparoscopic proctectomy with colostomy rather than pouch reconstruction.

Is a diverting ileostomy included?

Yes. The service includes a diverting ileostomy when performed, so its presence does not change the choice of 45397.

What operative details support 45397?

Document the laparoscopic approach, complete rectal removal, ileal reservoir construction, and ileoanal anastomosis. Note whether a diverting ileostomy was created.

Can modifier 50 be used?

No. The procedure involves unpaired anatomy, so modifier 50 is inappropriate.

How are multiple 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 is the postoperative global period?

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

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 45397PPRRVU2026_Oct_nonQPP.csv, line 5,529 (RVU26D)

Open CMS sourceHow we calculate rates

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