Billing code 45520: Rectal prolapse treatmentMedicare rate & RVUs
Reports a local treatment for rectal prolapse, such as injection therapy, rather than a formal abdominal or perineal prolapse repair.
Medicare pays $168.67 for 45520 nationally in the office and $37.74 in a hospital or facility. Local office rates run $146.63–$235.12.
Medicare rate · 45520
Rectal prolapse treatment
Swap in your local Medicare rate.
- Work RVUs
- 0.54
- Total RVUs
- 5.05
- Global days
- 000
National rate · 2026
$168.67
Office setting, before claim adjustments.
See every locality for 45520 → · 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
What 45520 covers
This service covers a treatment directed at rectal prolapse without the formal abdominal or perineal repair described by the related repair codes. A colorectal or general surgeon may perform a local treatment, such as injection therapy, in an outpatient setting. The record should identify the prolapse and the treatment method performed so the service can be distinguished from repair of the rectum or surgery to correct prolapse through an abdominal or perineal approach.
Report the service based on the treatment actually performed, not simply the diagnosis of prolapse. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are 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 45520 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$146.63 to $235.12
109 of 109 payment localities
45520 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.
$146.63
$208.63
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $186.28 | 1 |
| AL | $149.12 | 1 |
| AR | $146.63 | 1 |
| AZ | $163.74 | 1 |
| CA | $182.13–$235.12 | 29 |
| CO | $177.87 | 1 |
| CT | $180.95 | 1 |
| DC | $196.31 | 1 |
| DE | $166.75 | 1 |
| FL | $163.33–$178.33 | 3 |
| GA | $153.11–$171.57 | 2 |
| GU | $188.01 | 1 |
| HI | $188.01 | 1 |
| IA | $154.66 | 1 |
| ID | $155.58 | 1 |
| IL | $157.09–$174.61 | 4 |
| IN | $156.65 | 1 |
| KS | $153.28 | 1 |
| KY | $152.01 | 1 |
| LA | $151.52–$160.24 | 2 |
| MA | $176.35–$197.93 | 2 |
| MD | $170.44–$196.31 | 3 |
| ME | $155.93–$166.48 | 2 |
| MI | $156.07–$165.09 | 2 |
| MN | $171.33 | 1 |
| MO | $148.15–$161.56 | 3 |
| MS | $147.45 | 1 |
| MT | $168.67 | 1 |
| NC | $157.89 | 1 |
| ND | $167.29 | 1 |
| NE | $155.80 | 1 |
| NH | $174.46 | 1 |
| NJ | $183.27–$193.70 | 2 |
| NM | $156.84 | 1 |
| NV | $168.43 | 1 |
| NY | $160.57–$199.86 | 5 |
| OH | $155.79 | 1 |
| OK | $152.29 | 1 |
| OR | $167.39–$184.83 | 2 |
| PA | $156.39–$175.53 | 2 |
| PR | $170.27 | 1 |
| RI | $173.66 | 1 |
| SC | $157.05 | 1 |
| SD | $167.12 | 1 |
| TN | $154.10 | 1 |
| TX | $155.16–$177.05 | 8 |
| UT | $159.54 | 1 |
| VA | $165.47–$196.31 | 2 |
| VI | $170.27 | 1 |
| VT | $166.04 | 1 |
| WA | $176.21–$202.81 | 2 |
| WI | $160.83 | 1 |
| WV | $150.25 | 1 |
| WY | $168.07 | 1 |
How the 45520 rate is calculated
Each of 45520’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 · 45520
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.54Practice expense 4.44Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45520
The CMS indicators that decide how 45520 is paid alongside other services.
CMS payment indicators · 45520
Rectal prolapse treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45520 without 51 · national office
$168.67
Rectal prolapse treatment
45520-51 · Second procedure: 50%
$84.34
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%).
45520 compared with similar codes
Compare codes
45520 vs 45540 vs 45541 vs 45550: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45540Rectal prolapse repair
- Choose 45540 for repair of rectal prolapse through an abdominal approach; this code describes local treatment rather than that formal repair.
- 45541Prolapse repair
- Choose 45541 when the prolapse is repaired through a perineal approach. This code is for local treatment, not that approach-specific repair.
- 45550Rectal repair
- 45550 describes abdominal prolapse repair that includes sigmoid resection. This code does not represent that combined repair.
45520 billing questions
When should this code be chosen over a prolapse repair code?
Use it for a local treatment, such as injection therapy, rather than a formal abdominal or perineal repair. Select a repair code when the operative service matches that approach and repair.
What documentation supports reporting this service?
Document the rectal prolapse, the method used to treat it, and the work performed. The record should make clear that the service was not an abdominal or perineal repair.
Is same-day care included in the service?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
How is this code affected when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% 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
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