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Billing code 45825: Fistula repairMedicare rate & RVUs

Surgical closure of a communication between the rectum and urethra performed with a colostomy to divert stool and protect the repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,462.29 for 45825 nationally in a facility.

Medicare rate · 45825

Fistula repair

Work RVUs
23.57
Total RVUs
43.78
Global days
090

National rate · 2026

$1,462.29

Facility setting, before claim adjustments.

See every locality for 45825 →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 45825 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 45825 covers

This operation closes an abnormal passage between the rectum and urethra and creates a colostomy for fecal diversion. Colorectal or urologic surgeons may perform it for a fistula arising after pelvic surgery, radiation, trauma, or another disease process. The repair is typically undertaken in a hospital operating room, where the team can address the pelvic fistula and diversion during the same operative episode.

Report this code when the rectourethral fistula is surgically repaired with a colostomy; the operative report should identify the fistula site, repair performed, and diversion created. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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. An assistant at surgery may be paid; co-surgeon payment requires 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 45825 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

45825 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,312.79
Alaska*Unavailable$1,791.47
ArizonaUnavailable$1,417.55
ArkansasUnavailable$1,294.61
AtlantaUnavailable$1,514.44
AustinUnavailable$1,466.77
BakersfieldUnavailable$1,439.41
Baltimore/Surr. CntysUnavailable$1,558.73
BeaumontUnavailable$1,405.54
BrazoriaUnavailable$1,418.04

45825 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
45825 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 45825 rate is calculated

Each of 45825’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 · 45825

RVUs × geographic indexes × conversion factor

Work23.57

23.57 RVUs× 1.000 GPCI

Practice expense13.90

13.90 RVUs× 1.000 GPCI

Malpractice6.31

6.31 RVUs× 1.000 GPCI

Adjusted RVUs

43.7800

Conversion factor

$33.4009

Medicare rate

$1,462.29

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 45825

45825 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45825

Fistula 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 · 45825

Fistula 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

45825 without 51 · national facility

$1,462.29

Fistula repair

45825-51 · Second procedure: 50%

$731.15

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

45825 compared with similar codes

Compare codes · National

4 codes, side by side

  • 45825

    Fistula repair23.57 wRVU

    Not priced

  • 45820

    Fistula repair19.86 wRVU

    Not priced

  • 45800

    Fistula repair19.8 wRVU

    Not priced

  • 45805

    Fistula repair22.74 wRVU

    Not priced

How to choose

45820Fistula repair
Choose 45825 when rectourethral fistula repair is performed with a colostomy; 45820 represents the related repair without that colostomy circumstance.
45800Fistula repair
45800 concerns a fistula between the rectum and bladder. This code is for a rectourethral fistula repaired with a colostomy.
45805Fistula repair
Both involve fistula repair with colostomy, but 45805 is associated with a different fistula site; identify the involved organs in the operative report.

Codes related to 45825

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

Codes related to 45825
CodeHow it relatesNational office range
Same family
45820Fistula repairRectourethral fistula repair without the colostomy circumstance identified for 45825.No office rate
45800Fistula repairRelated fistula-repair code for a rectal-to-bladder fistula.No office rate
45805Fistula repairRelated fistula-repair code involving a colostomy and a different fistula site.No office rate

45825 billing questions

How does this differ from 45820?

Both concern rectourethral fistula repair, but 45825 is the selection when the repair is performed with a colostomy. Use 45820 when the applicable repair is performed without that colostomy.

Is the colostomy part of the service?

The code identifies rectourethral fistula repair performed with a colostomy. Document the diversion and its relationship to the repair; do not infer separate reporting from the presence of a colostomy alone.

Does modifier 50 apply?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant surgeon be paid?

CMS permits assistant-at-surgery payment for this code. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.

What postoperative care is included?

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

What happens when another procedure is performed in the same session?

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

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 45825PPRRVU2026_Oct_nonQPP.csv, line 5,563 (RVU26D)

Open CMS sourceHow we calculate rates

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