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Billing code 45400: RectopexyMedicare rate & RVUs

Laparoscopic proctopexy fixes the rectum for rectal prolapse; report this code when the procedure is performed without sigmoid resection.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.3K Medicare services in 2024

Medicare pays $1,044.45 for 45400 nationally in a facility.

Medicare rate · 45400

Rectopexy

Swap in your local Medicare rate.

Work RVUs
18.95
Total RVUs
31.27
Global days
090

National rate · 2026

$1,044.45

Facility setting, before claim adjustments.

See every locality for 45400 → · 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 45400 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 45400 covers

This operation uses a laparoscopic approach to secure the rectum in the pelvis for treatment of rectal prolapse. It is typically performed by a colorectal or general surgeon in a hospital or other surgical facility. This code describes proctopexy without sigmoid resection; when sigmoid resection is part of the prolapse operation, a different code applies.

Report the procedure performed, supported by documentation of the prolapse, laparoscopic approach, rectopexy, and whether sigmoid resection was done. 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 others are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons require 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 45400 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

45400 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$958.33
Alaska*Unavailable$1,329.98
ArizonaUnavailable$1,019.01
ArkansasUnavailable$947.82
AtlantaUnavailable$1,073.69
AustinUnavailable$1,050.28
BakersfieldUnavailable$1,041.32
Baltimore/Surr. CntysUnavailable$1,103.02
BeaumontUnavailable$1,009.54
BrazoriaUnavailable$1,022.13

45400 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
45400 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 45400 rate is calculated

Each of 45400’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 · 45400

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.95Practice expense 8.96Malpractice 3.36

31.2700 adjusted RVUs×$33.4009 conversion factor=$1,044.45

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

Payment rules and modifiers for 45400

45400 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45400

Rectopexy

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 · 45400

Rectopexy

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

45400 without 51 · national facility

$1,044.45

Rectopexy

45400-51 · Second procedure: 50%

$522.23

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

45400 compared with similar codes

Compare codes

45400 vs 45402 vs 45540 vs 45550: national Medicare rates

Swap in your local Medicare rate.

  • 45400
    Rectopexy · 18.95 wRVU
    —
  • 45402
    Laparoscopic rectopexy · 25.85 wRVU
    —
  • 45540
    Rectal prolapse repair · 17.67 wRVU
    —
  • 45550
    Rectal repair · 24.18 wRVU
    —

How to choose

45402Laparoscopic rectopexy
Both describe laparoscopic proctopexy for prolapse. Choose 45402 when sigmoid resection is part of the operation; 45400 is for proctopexy without that resection.
45540Rectal prolapse repair
This code describes abdominal proctopexy by an open approach. Use 45400 when the rectopexy is performed laparoscopically.
45550Rectal repair
This code describes open abdominal proctopexy with sigmoid resection. For a laparoscopic repair with resection, compare 45402.

Codes related to 45400

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

Codes related to 45400
CodeHow it relatesNational office range
Same family
45402Laparoscopic rectopexyLaparoscopic proctopexy for prolapse when sigmoid resection is also performed.No office rate
Used instead
45540Rectal prolapse repairAbdominal proctopexy for prolapse using an open approach.No office rate
45550Rectal repairOpen abdominal proctopexy for prolapse with sigmoid resection.No office rate

45400 billing questions

When should 45400 be reported instead of 45402?

Use 45400 for laparoscopic proctopexy without sigmoid resection. When sigmoid resection is performed as part of the prolapse operation, use 45402.

Can modifier 50 be used for this procedure?

No. The descriptor and anatomy make bilateral reporting with modifier 50 inappropriate.

What does the 90-day global period include?

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided.

How are other procedures in the same session handled?

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

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 45400PPRRVU2026_Oct_nonQPP.csv, line 5,532 (RVU26D)

Open CMS sourceHow we calculate rates

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