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Billing code 45563: Rectal repairMedicare rate & RVUs

Reports operative exploration and repair of the rectum performed with colostomy creation, such as in selected congenital rectal conditions or rectal injuries.

CMS RVU26DEffective Oct 1, 2026109 payment localities19 Medicare services in 2024

Medicare pays $1,569.84 for 45563 nationally in a facility.

Medicare rate · 45563

Rectal repair

Swap in your local Medicare rate.

Work RVUs
25.72
Total RVUs
47.00
Global days
090

National rate · 2026

$1,569.84

Facility setting, before claim adjustments.

See every locality for 45563 → · 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 45563 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 45563 covers

A colorectal or general surgeon uses this service when operative exploration and rectal repair are performed together with creation of a colostomy. A congenital anorectal condition, such as imperforate anus, is a representative clinical context; the exact operative plan depends on the anatomy and findings. This is generally an operating-room service rather than an office procedure.

Report the code when the operative record supports both rectal exploration and repair and colostomy creation as part of the operation. The 90-day global package includes the day-before preoperative visit and related postoperative care through day 90. 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% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted. Report this as a single rectal operation, not a bilateral procedure using modifier 50.

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 45563 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

45563 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,410.19
Alaska*Unavailable$1,927.81
ArizonaUnavailable$1,521.92
ArkansasUnavailable$1,390.80
AtlantaUnavailable$1,626.18
AustinUnavailable$1,573.37
BakersfieldUnavailable$1,542.81
Baltimore/Surr. CntysUnavailable$1,673.05
BeaumontUnavailable$1,510.23
BrazoriaUnavailable$1,521.97

45563 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
45563 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 45563 rate is calculated

Each of 45563’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 · 45563

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 25.72Practice expense 14.42Malpractice 6.86

47.0000 adjusted RVUs×$33.4009 conversion factor=$1,569.84

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

Payment rules and modifiers for 45563

45563 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45563

Rectal repair

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 · 45563

Rectal repair

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

45563 without 51 · national facility

$1,569.84

Rectal repair

45563-51 · Second procedure: 50%

$784.92

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

45563 compared with similar codes

Compare codes

45563 vs 45562 vs 45500 vs 45520: national Medicare rates

Swap in your local Medicare rate.

  • 45563
    Rectal repair · 25.72 wRVU
    —
  • 45562
    Rectal injury repair · 17.53 wRVU
    —
  • 45500
    Rectal injury repair · 7.54 wRVU
    —
  • 45520
    Rectal prolapse treatment · 0.54 wRVU
    $168.67

How to choose

45562Rectal injury repair
45563 includes colostomy creation with rectal exploration and repair. 45562 is the related exploration-and-repair service without that colostomy component.
45500Rectal injury repair
45500 describes a rectal repair service; choose 45563 when the documented operation also includes rectal exploration and colostomy creation.
45520Rectal prolapse treatment
45520 is for treatment of rectal prolapse. 45563 concerns exploration and repair of the rectum with colostomy creation.

Codes related to 45563

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

Codes related to 45563
CodeHow it relatesNational office range
Same family
45562Rectal injury repairRectal exploration and repair without the colostomy component described by 45563.No office rate
Used instead
45500Rectal injury repairA rectal repair service for cases not involving the combined exploration and colostomy service.No office rate
45505Rectal repairA separate rectal repair option when the operative service does not match 45563.No office rate
45520Rectal prolapse treatmentTreats rectal prolapse rather than the exploration, repair, and colostomy service.$146.63–$235.12

45563 billing questions

How is 45563 distinguished from 45562?

45563 describes rectal exploration and repair performed with colostomy creation. Use 45562 when exploration and repair are performed without the colostomy component described by 45563.

Can the colostomy be reported separately?

The colostomy is part of the service described by 45563. Review the operative report to confirm that both the rectal work and colostomy creation were performed.

What documentation supports 45563?

The operative report should describe the rectal exploration, the repair performed, and creation of the colostomy. Include the clinical condition and relevant operative findings.

Can modifier 50 be used?

No. Report the rectal operation as a single procedure; modifier 50 is inappropriate for this service.

How are other same-session procedures handled?

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

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team-surgery billing 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 45563PPRRVU2026_Oct_nonQPP.csv, line 5,551 (RVU26D)

Open CMS sourceHow we calculate rates

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