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Billing code 45905: Anal dilationMedicare rate & RVUs

Reports procedural dilation of the anal sphincter, commonly to relieve sphincter tightness associated with an anal fissure.

CMS RVU26DEffective Oct 1, 2026109 payment localities336 Medicare services in 2024

Medicare pays $169.01 for 45905 nationally in a facility.

Medicare rate · 45905

Anal dilation

Swap in your local Medicare rate.

Work RVUs
2.29
Total RVUs
5.06
Global days
010

National rate · 2026

$169.01

Facility setting, before claim adjustments.

See every locality for 45905 → · 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 45905 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 45905 covers

A colorectal or general surgeon dilates the anal sphincter to relieve tightness or spasm, often in a patient with an anal fissure. The procedure addresses the sphincter itself; it is distinct from dilation directed at a narrowing higher in the rectum. It may be performed in a procedural setting or operating room, depending on the patient and technique.

Report the service when the record supports actual sphincter dilation and identifies the indication and the structure treated. Document the relevant examination findings and the procedure performed; an evaluation or examination alone does not establish that dilation occurred. CMS assigns a 10-day global period, so related postoperative visits during that period are 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. The anatomy is not suited to modifier 50. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing 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 45905 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

45905 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$153.11
Alaska*Unavailable$206.06
ArizonaUnavailable$164.56
ArkansasUnavailable$151.14
AtlantaUnavailable$173.31
AustinUnavailable$172.11
BakersfieldUnavailable$172.51
Baltimore/Surr. CntysUnavailable$179.29
BeaumontUnavailable$160.95
BrazoriaUnavailable$165.83

45905 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
45905 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 45905 rate is calculated

Each of 45905’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 · 45905

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.29Practice expense 2.35Malpractice 0.42

5.0600 adjusted RVUs×$33.4009 conversion factor=$169.01

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

Payment rules and modifiers for 45905

45905 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 45905

Anal dilation

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 45905

Anal dilation

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

45905 without 51 · national facility

$169.01

Anal dilation

45905-51 · Second procedure: 50%

$84.51

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

45905 compared with similar codes

Compare codes

45905 vs 45910 vs 46080 vs 46200: national Medicare rates

Swap in your local Medicare rate.

  • 45905
    Anal dilation · 2.29 wRVU
    —
  • 45910
    Rectal dilation · 2.78 wRVU
    —
  • 46080
    Anal sphincterotomy · 2.46 wRVU
    $315.64
  • 46200
    Fissure surgery · 3.5 wRVU
    $530.74

How to choose

45910Rectal dilation
Choose 45905 for dilation of the anal sphincter; choose 45910 when the treated site is a rectal narrowing.
46080Anal sphincterotomy
45905 describes dilation of the anal sphincter. 46080 describes lateral sphincterotomy, a separate operative treatment for an anal fissure.
46200Fissure surgery
45905 is sphincter dilation; 46200 is fissurectomy, with sphincterotomy when performed. The documented procedure, not the fissure diagnosis alone, determines the code.

Codes related to 45905

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

Codes related to 45905
CodeHow it relatesNational office range
Used instead
45910Rectal dilationUse when dilation targets a rectal narrowing rather than the anal sphincter.No office rate
46080Anal sphincterotomyA sphincterotomy is a different operative approach for treating an anal fissure.$277.09–$413.04
46200Fissure surgeryFissurectomy is an excisional approach to anal fissure, rather than sphincter dilation.$465.50–$708.36

45905 billing questions

When is 45905 appropriate for a patient with an anal fissure?

Use it when the documented procedure dilates the anal sphincter, such as to address fissure-associated tightness or spasm. A fissure diagnosis by itself does not show that sphincter dilation was performed.

How is 45905 different from 45910?

45905 treats the anal sphincter. 45910 is for dilation directed at a rectal narrowing, so select based on the structure actually dilated.

Does 45905 have a postoperative global period?

Yes. CMS assigns a 10-day global period, which includes related postoperative visits during that period.

Can modifier 50 be used for 45905?

No. The anatomy and service do not support bilateral reporting with modifier 50.

How does Medicare handle 45905 when another procedure is performed in the same session?

Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Medicare does not pay an assistant at surgery; co-surgeons and team surgeons are 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 45905PPRRVU2026_Oct_nonQPP.csv, line 5,565 (RVU26D)

Open CMS sourceHow we calculate rates

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