No office rate
Both address a rectourethral fistula. Choose 45825 when the repair includes colostomy; use 45820 for the repair without that variant.
On this page
CMS RVU26D · Effective 2026-10-01
45820 in Chico
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1176.94
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Colorectal surgery
About 45820: Rectourethral fistula repair
Reports operative closure of an abnormal connection between the rectum and urethra, selected when that specific tract is repaired without the colostomy variant.
This service repairs a tract connecting the rectum and urethra. Patients may have urine passing through the rectum, recurrent urinary infections, or fecal contamination of the urinary tract. A colorectal surgeon, urologist, or both may perform the repair, commonly in a hospital operating room. The condition may follow pelvic surgery, radiation, or injury; the operative report should identify the tract and describe its closure.
Select this code for repair of the rectourethral connection; a repair that includes colostomy is represented by a different code in this family. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be allowed; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45820
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU19.86 · 55%
- Practice expense (office) RVU11.13 · 31%
- Malpractice RVU5.30 · 15%
55
Medicare services in 2024 · #5302 by national volume
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.
45820 compared with similar codes
Office rates for Chico, from the same CMS release.
No office rate
This code addresses a rectal-to-bladder fistula. Use 45820 when the tract connects the rectum to the urethra.
No office rate
This is a fistula repair variant that includes colostomy. Distinguish it from 45820 by the tract and the procedure documented.
The same code, a different location
How does Chico compare?
45820 across payment areas
Same release and payment basis · bars start at $0
Chico · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Modesto
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Napa
California · 45820
Office
Unavailable
Facility
$1285.03
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 45820
Office
Unavailable
Facility
$1231.61
No comparable office rate is available.
Redding
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Rest Of California
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 45820
Office
Unavailable
Facility
$1233.72
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 45820
Office
Unavailable
Facility
$1214.46
No comparable office rate is available.
Salinas
California · 45820
Office
Unavailable
Facility
$1209.65
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 45820
Office
Unavailable
Facility
$1223.80
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 45820
Office
Unavailable
Facility
$1331.78
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 45820
Office
Unavailable
Facility
$1325.77
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 45820
Office
Unavailable
Facility
$1367.26
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 45820
Office
Unavailable
Facility
$1342.65
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 45820
Office
Unavailable
Facility
$1192.93
No comparable office rate is available.
Santa Cruz-Watsonville
California · 45820
Office
Unavailable
Facility
$1223.84
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 45820
Office
Unavailable
Facility
$1210.26
No comparable office rate is available.
Santa Rosa-Petaluma
California · 45820
Office
Unavailable
Facility
$1234.64
No comparable office rate is available.
Stockton
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Vallejo
California · 45820
Office
Unavailable
Facility
$1276.36
No comparable office rate is available.
Visalia
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Yuba City
California · 45820
Office
Unavailable
Facility
$1176.94
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 45820
Office
Unavailable
Facility
$1334.11
No comparable office rate is available.
Miami
Florida · 45820
Office
Unavailable
Facility
$1498.03
No comparable office rate is available.
Chicago
Illinois · 45820
Office
Unavailable
Facility
$1447.87
No comparable office rate is available.
Manhattan
New York · 45820
Office
Unavailable
Facility
$1418.53
No comparable office rate is available.
Alaska*
Alaska · 45820
Office
Unavailable
Facility
$1488.47
No comparable office rate is available.
Alabama
Alabama · 45820
Office
Unavailable
Facility
$1088.82
No comparable office rate is available.
Arkansas
Arkansas · 45820
Office
Unavailable
Facility
$1073.84
No comparable office rate is available.
Arizona
Arizona · 45820
Office
Unavailable
Facility
$1175.10
No comparable office rate is available.
Colorado
Colorado · 45820
Office
Unavailable
Facility
$1205.10
No comparable office rate is available.
Connecticut
Connecticut · 45820
Office
Unavailable
Facility
$1291.19
No comparable office rate is available.
Delaware
Delaware · 45820
Office
Unavailable
Facility
$1193.09
No comparable office rate is available.
Fort Lauderdale
Florida · 45820
Office
Unavailable
Facility
$1359.99
No comparable office rate is available.
Rest Of Florida
Florida · 45820
Office
Unavailable
Facility
$1284.81
No comparable office rate is available.
Atlanta
Georgia · 45820
Office
Unavailable
Facility
$1255.64
No comparable office rate is available.
Rest Of Georgia
Georgia · 45820
Office
Unavailable
Facility
$1205.96
No comparable office rate is available.
Hawaii, Guam
Hawaii · 45820
Office
Unavailable
Facility
$1188.52
No comparable office rate is available.
Iowa
Iowa · 45820
Office
Unavailable
Facility
$1073.77
No comparable office rate is available.
Idaho
Idaho · 45820
Office
Unavailable
Facility
$1089.09
No comparable office rate is available.
East St. Louis
Illinois · 45820
Office
Unavailable
Facility
$1361.88
No comparable office rate is available.
Rest Of Illinois
Illinois · 45820
Office
Unavailable
Facility
$1279.44
No comparable office rate is available.
Suburban Chicago
Illinois · 45820
Office
Unavailable
Facility
$1363.46
No comparable office rate is available.
Indiana
Indiana · 45820
Office
Unavailable
Facility
$1093.99
No comparable office rate is available.
Kansas
Kansas · 45820
Office
Unavailable
Facility
$1088.63
No comparable office rate is available.
Kentucky
Kentucky · 45820
Office
Unavailable
Facility
$1155.81
No comparable office rate is available.
New Orleans
Louisiana · 45820
Office
Unavailable
Facility
$1214.26
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 45820
Office
Unavailable
Facility
$1161.93
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 45820
Office
Unavailable
Facility
$1291.96
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 45820
Office
Unavailable
Facility
$1206.50
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 45820
Office
Unavailable
Facility
$1291.82
No comparable office rate is available.
Rest Of Maryland
Maryland · 45820
Office
Unavailable
Facility
$1208.70
No comparable office rate is available.
Rest Of Maine
Maine · 45820
Office
Unavailable
Facility
$1115.46
No comparable office rate is available.
Southern Maine
Maine · 45820
Office
Unavailable
Facility
$1143.45
No comparable office rate is available.
Detroit
Michigan · 45820
Office
Unavailable
Facility
$1320.55
No comparable office rate is available.
Rest Of Michigan
Michigan · 45820
Office
Unavailable
Facility
$1202.61
No comparable office rate is available.
Minnesota
Minnesota · 45820
Office
Unavailable
Facility
$1098.27
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 45820
Office
Unavailable
Facility
$1185.37
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 45820
Office
Unavailable
Facility
$1194.63
No comparable office rate is available.
Rest Of Missouri
Missouri · 45820
Office
Unavailable
Facility
$1156.21
No comparable office rate is available.
Mississippi
Mississippi · 45820
Office
Unavailable
Facility
$1114.24
No comparable office rate is available.
Montana**
Montana · 45820
Office
Unavailable
Facility
$1211.76
No comparable office rate is available.
North Carolina
North Carolina · 45820
Office
Unavailable
Facility
$1123.31
No comparable office rate is available.
North Dakota**
North Dakota · 45820
Office
Unavailable
Facility
$1106.97
No comparable office rate is available.
Nebraska
Nebraska · 45820
Office
Unavailable
Facility
$1073.38
No comparable office rate is available.
New Hampshire
New Hampshire · 45820
Office
Unavailable
Facility
$1205.23
No comparable office rate is available.
Northern Nj
New Jersey · 45820
Office
Unavailable
Facility
$1325.43
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 45820
Office
Unavailable
Facility
$1290.02
No comparable office rate is available.
New Mexico
New Mexico · 45820
Office
Unavailable
Facility
$1216.85
No comparable office rate is available.
Nevada**
Nevada · 45820
Office
Unavailable
Facility
$1182.93
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 45820
Office
Unavailable
Facility
$1476.54
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 45820
Office
Unavailable
Facility
$1314.46
No comparable office rate is available.
Queens
New York · 45820
Office
Unavailable
Facility
$1400.48
No comparable office rate is available.
Rest Of New York
New York · 45820
Office
Unavailable
Facility
$1140.95
No comparable office rate is available.
Ohio
Ohio · 45820
Office
Unavailable
Facility
$1181.19
No comparable office rate is available.
Oklahoma
Oklahoma · 45820
Office
Unavailable
Facility
$1132.86
No comparable office rate is available.
Portland
Oregon · 45820
Office
Unavailable
Facility
$1218.68
No comparable office rate is available.
Rest Of Oregon
Oregon · 45820
Office
Unavailable
Facility
$1158.06
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 45820
Office
Unavailable
Facility
$1273.47
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 45820
Office
Unavailable
Facility
$1171.90
No comparable office rate is available.
Puerto Rico
Puerto Rico · 45820
Office
Unavailable
Facility
$1213.55
No comparable office rate is available.
Rhode Island
Rhode Island · 45820
Office
Unavailable
Facility
$1217.87
No comparable office rate is available.
South Carolina
South Carolina · 45820
Office
Unavailable
Facility
$1157.31
No comparable office rate is available.
South Dakota**
South Dakota · 45820
Office
Unavailable
Facility
$1094.57
No comparable office rate is available.
Tennessee
Tennessee · 45820
Office
Unavailable
Facility
$1096.33
No comparable office rate is available.
Austin
Texas · 45820
Office
Unavailable
Facility
$1214.83
No comparable office rate is available.
Beaumont
Texas · 45820
Office
Unavailable
Facility
$1166.09
No comparable office rate is available.
Brazoria
Texas · 45820
Office
Unavailable
Facility
$1175.13
No comparable office rate is available.
Dallas
Texas · 45820
Office
Unavailable
Facility
$1191.46
No comparable office rate is available.
Fort Worth
Texas · 45820
Office
Unavailable
Facility
$1190.05
No comparable office rate is available.
Galveston
Texas · 45820
Office
Unavailable
Facility
$1184.37
No comparable office rate is available.
Houston
Texas · 45820
Office
Unavailable
Facility
$1281.38
No comparable office rate is available.
Rest Of Texas
Texas · 45820
Office
Unavailable
Facility
$1175.99
No comparable office rate is available.
Utah
Utah · 45820
Office
Unavailable
Facility
$1171.76
No comparable office rate is available.
Virginia
Virginia · 45820
Office
Unavailable
Facility
$1153.75
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 45820
Office
Unavailable
Facility
$1213.55
No comparable office rate is available.
Vermont
Vermont · 45820
Office
Unavailable
Facility
$1120.95
No comparable office rate is available.
Rest Of Washington
Washington · 45820
Office
Unavailable
Facility
$1198.14
No comparable office rate is available.
Seattle (King Cnty)
Washington · 45820
Office
Unavailable
Facility
$1297.28
No comparable office rate is available.
Wisconsin
Wisconsin · 45820
Office
Unavailable
Facility
$1074.00
No comparable office rate is available.
West Virginia
West Virginia · 45820
Office
Unavailable
Facility
$1239.72
No comparable office rate is available.
Wyoming**
Wyoming · 45820
Office
Unavailable
Facility
$1166.09
No comparable office rate is available.
See how rates vary across the country
45820 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Chico is a Medicare payment area. Our Census mapping connects it to 30 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 45820 in Chico. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1294.63
$1176.94 × 110% = $1294.63
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45820 in Chico.
PPRRVU2026_Oct_nonQPP.csv
5,562
- Code
- 45820
- Physician work
- 19.86
- Practice expense
- 11.13
- Malpractice
- 5.30
GPCI2026.csv
9
- Locality
- Chico
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.86 | × 1.017 | 20.1976 |
| Practice expense | 11.13 | × 1.096 | 12.1985 |
| Malpractice | 5.30 | × 0.536 | 2.8408 |
| Total RVUs | 35.2369 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Chico$1176.94
Open 45820 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.86 | 1.017 |
| Practice expense | 11.13 | 1.096 |
| Malpractice | 5.3 | 0.536 |
(19.86 × 1.017 + 11.13 × 1.096 + 5.3 × 0.536) × $33.4009 = $1176.94
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
45820 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1176.94 | RVU26D |
| 2026-07-01 | Not available in this setting | $1176.94 | RVU26C |
| 2026-04-01 | Not available in this setting | $1176.94 | RVU26B |
| 2026-01-01 | Not available in this setting | $1176.94 | RVU26A |
| 2025-10-01 | Not available in this setting | $1220.15 | RVU25D |
| 2025-07-01 | Not available in this setting | $1220.15 | RVU25C |
| 2025-04-01 | Not available in this setting | $1220.15 | RVU25B |
| 2025-01-01 | Not available in this setting | $1220.15 | RVU25A |
45820 billing questions
How is this code distinguished from 45825?
Use 45820 for repair of the rectourethral fistula without the colostomy variant. Code 45825 represents rectourethral fistula repair with colostomy.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
How are other same-session procedures paid?
Under the standard multiple procedure rule, the highest-valued procedure is paid in full and other procedures are reduced to 50% when performed in the same session.
What documentation supports reporting 45820?
The operative report should establish that the fistula connects the rectum and urethra and describe the repair. Document any colostomy procedure separately as part of selecting the appropriate code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation; 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.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,5594563F,,Pt recvd aspirin w/in 24 hrs,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56045800,,Repair rect/bladder fistula,A,,19.80,11.12,NA,11.12,,5.29,36.21,36.21,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56145805,,Repair fistula w/colostomy,A,,22.74,12.89,NA,12.89,,6.08,41.71,41.71,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56245820,,Repair rectourethral fistula,A,,19.86,11.13,NA,11.13,,5.30,36.29,36.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56345825,,Repair fistula w/colostomy,A,,23.57,13.90,NA,13.90,,6.31,43.78,43.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56445900,,Reduction of rectal prolapse,A,,2.92,2.62,NA,2.62,,0.79,6.33,6.33,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56545905,,Dilation of anal sphincter,A,,2.29,2.35,NA,2.35,,0.42,5.06,5.06,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536
1001182,CA,71,EL CENTRO,1.017,1.096,0.541
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536