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Billing code 45990: Anorectal examMedicare rate & RVUs

A surgeon examines the anal canal and distal rectum under anesthesia when pain, spasm, or limited access prevents an adequate diagnostic office examination.

CMS RVU26DEffective Oct 1, 2026109 payment localities3.9K Medicare services in 2024

Medicare pays $99.53 for 45990 nationally in a facility.

Medicare rate · 45990

Anorectal exam

Swap in your local Medicare rate.

Work RVUs
1.76
Total RVUs
2.98
Global days
000

National rate · 2026

$99.53

Facility setting, before claim adjustments.

See every locality for 45990 → · 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 45990 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 45990 covers

This service is a diagnostic examination of the anal canal and distal rectum performed under anesthesia, typically by a colorectal or general surgeon in an operating room or other procedural setting. It is useful when pain, sphincter spasm, or inability to tolerate positioning prevents a reliable office assessment—for example, when evaluating persistent anorectal pain, bleeding, or a suspected lesion. The code represents the diagnostic examination, not treatment of a prolapse, narrowing, or obstruction.

Report it when the record supports why an examination under anesthesia was needed, what areas and findings were assessed, and the diagnostic purpose. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Assistant-at-surgery, co-surgeon, and team-surgery payment requires documentation supporting medical necessity.

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 45990 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

45990 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$90.83
Alaska*Unavailable$125.57
ArizonaUnavailable$96.95
ArkansasUnavailable$89.77
AtlantaUnavailable$102.53
AustinUnavailable$100.00
BakersfieldUnavailable$98.87
Baltimore/Surr. CntysUnavailable$105.37
BeaumontUnavailable$96.09
BrazoriaUnavailable$97.17

45990 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
45990 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 45990 rate is calculated

Each of 45990’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 · 45990

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 1.76Practice expense 0.87Malpractice 0.35

2.9800 adjusted RVUs×$33.4009 conversion factor=$99.53

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

Payment rules and modifiers for 45990

The CMS indicators that decide how 45990 is paid alongside other services.

CMS payment indicators · 45990

Anorectal exam

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)0Not paid without supporting documentation.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

45990 without 51 · national facility

$99.53

Anorectal exam

45990-51 · Second procedure: 50%

$49.77

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

45990 compared with similar codes

Compare codes

45990 vs 46600 vs 45905 vs 45910: national Medicare rates

Swap in your local Medicare rate.

  • 45990
    Anorectal exam · 1.76 wRVU
    —
  • 46600
    Diagnostic anoscopy · 0.54 wRVU
    $128.93
  • 45905
    Anal dilation · 2.29 wRVU
    —
  • 45910
    Rectal dilation · 2.78 wRVU
    —

How to choose

46600Diagnostic anoscopy
46600 is diagnostic anoscopy without the examination-under-anesthesia service. Choose 45990 when anesthesia is needed to complete a reliable anorectal examination.
45905Anal dilation
45905 is an anal sphincter dilation procedure. 45990 is diagnostic and does not represent dilation.
45910Rectal dilation
45910 treats rectal narrowing by dilation; 45990 documents a diagnostic anorectal examination rather than treatment of a stricture.

Codes related to 45990

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

Codes related to 45990
CodeHow it relatesNational office range
Used instead
46600Diagnostic anoscopyDiagnostic anoscopy may meet the need when an office examination is adequate.$112.37–$177.50
45300ProctosigmoidoscopyRigid proctosigmoidoscopy provides a different diagnostic examination when deeper rectal visualization is needed.$129.86–$201.75
46606Anoscopy biopsyAnoscopy with biopsy is an alternative when an accessible lesion requires tissue sampling.$266.89–$423.60

45990 billing questions

When is 45990 more appropriate than office anoscopy?

Use 45990 when an adequate diagnostic anorectal examination requires anesthesia, such as when pain or spasm prevents a reliable office examination. An office anoscopy is appropriate when the patient can tolerate that examination.

Does 45990 describe treatment of a finding?

No. It describes a diagnostic examination. A service that treats a prolapse, anal narrowing, or rectal obstruction has its own procedure code and must be supported by the operative record.

What documentation supports reporting 45990?

Document the reason an examination under anesthesia was needed, the diagnostic purpose, the areas examined, and the findings. The record should make clear why an office examination was inadequate.

How is same-session multiple-procedure payment handled?

When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon and team-surgery payment also require supporting documentation.

What care is included in the global period?

The 0-day global period includes same-day preoperative and postoperative care.

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 45990PPRRVU2026_Oct_nonQPP.csv, line 5,568 (RVU26D)

Open CMS sourceHow we calculate rates

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