No office rate
45120 covers rectal resection without the combined colon removal represented by 45121. Select based on the documented organs removed.
On this page
CMS RVU26D · Effective 2026-10-01
45121 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1604.27
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 45121: Complete proctocolectomy with ileostomy
Reports complete removal of the colon and rectum with ileostomy reconstruction, such as for extensive colorectal disease requiring permanent diversion.
This code represents a complete resection of the colon and rectum with creation of an ileostomy. Colorectal surgeons typically perform it in an operating room for conditions requiring removal of both organs, including severe ulcerative colitis or familial adenomatous polyposis. The operative report should establish the extent of resection and the ileostomy reconstruction; a rectal-only operation or a procedure creating an ileoanal reservoir is a different service.
Report the code when the documented operation matches the complete colorectal resection and ileostomy service, rather than coding the colon and rectum removals separately. 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 additional procedures are subject to the standard 50% multiple-procedure reduction. A bilateral adjustment is not appropriate for this single colorectal resection. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45121
- 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 RVU28.35 · 58%
- Practice expense (office) RVU12.87 · 26%
- Malpractice RVU7.59 · 16%
16
Medicare services in 2024 · #6040 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.
45121 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
45119 describes reconstruction with an ileoanal reservoir; 45121 is for the complete colon-and-rectum resection with ileostomy.
No office rate
45110 is a complete abdominoperineal rectal resection with colostomy. It does not describe the combined colon and rectum removal with ileostomy in 45121.
No office rate
45111 is a partial rectal resection with anastomosis. It is not the complete removal of both colon and rectum represented by 45121.
The same code, a different location
How does Delaware compare?
45121 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
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.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware 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
Alabama
Alabama · 45121
Office
Unavailable
Facility
$1466.54
No comparable office rate is available.
Arkansas
Arkansas · 45121
Office
Unavailable
Facility
$1446.73
No comparable office rate is available.
Arizona
Arizona · 45121
Office
Unavailable
Facility
$1580.47
No comparable office rate is available.
Bakersfield
California · 45121
Office
Unavailable
Facility
$1590.43
No comparable office rate is available.
Chico
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
El Centro
California · 45121
Office
Unavailable
Facility
$1571.30
No comparable office rate is available.
Fresno
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Hanford-Corcoran
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Madera
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Merced
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Modesto
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Napa
California · 45121
Office
Unavailable
Facility
$1701.92
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 45121
Office
Unavailable
Facility
$1639.47
No comparable office rate is available.
Redding
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Rest Of California
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 45121
Office
Unavailable
Facility
$1651.34
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 45121
Office
Unavailable
Facility
$1616.83
No comparable office rate is available.
Salinas
California · 45121
Office
Unavailable
Facility
$1610.37
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 45121
Office
Unavailable
Facility
$1626.85
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 45121
Office
Unavailable
Facility
$1759.35
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 45121
Office
Unavailable
Facility
$1750.73
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 45121
Office
Unavailable
Facility
$1806.83
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 45121
Office
Unavailable
Facility
$1771.59
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 45121
Office
Unavailable
Facility
$1588.52
No comparable office rate is available.
Santa Cruz-Watsonville
California · 45121
Office
Unavailable
Facility
$1624.98
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 45121
Office
Unavailable
Facility
$1610.54
No comparable office rate is available.
Santa Rosa-Petaluma
California · 45121
Office
Unavailable
Facility
$1639.09
No comparable office rate is available.
Stockton
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Vallejo
California · 45121
Office
Unavailable
Facility
$1689.50
No comparable office rate is available.
Visalia
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Yuba City
California · 45121
Office
Unavailable
Facility
$1570.03
No comparable office rate is available.
Colorado
Colorado · 45121
Office
Unavailable
Facility
$1613.65
No comparable office rate is available.
Connecticut
Connecticut · 45121
Office
Unavailable
Facility
$1735.57
No comparable office rate is available.
Fort Lauderdale
Florida · 45121
Office
Unavailable
Facility
$1840.72
No comparable office rate is available.
Rest Of Florida
Florida · 45121
Office
Unavailable
Facility
$1738.90
No comparable office rate is available.
Atlanta
Georgia · 45121
Office
Unavailable
Facility
$1690.97
No comparable office rate is available.
Rest Of Georgia
Georgia · 45121
Office
Unavailable
Facility
$1632.55
No comparable office rate is available.
Hawaii, Guam
Hawaii · 45121
Office
Unavailable
Facility
$1582.46
No comparable office rate is available.
Iowa
Iowa · 45121
Office
Unavailable
Facility
$1440.89
No comparable office rate is available.
Idaho
Idaho · 45121
Office
Unavailable
Facility
$1462.31
No comparable office rate is available.
East St. Louis
Illinois · 45121
Office
Unavailable
Facility
$1852.97
No comparable office rate is available.
Rest Of Illinois
Illinois · 45121
Office
Unavailable
Facility
$1735.63
No comparable office rate is available.
Suburban Chicago
Illinois · 45121
Office
Unavailable
Facility
$1844.24
No comparable office rate is available.
Indiana
Indiana · 45121
Office
Unavailable
Facility
$1468.61
No comparable office rate is available.
Kansas
Kansas · 45121
Office
Unavailable
Facility
$1463.29
No comparable office rate is available.
Kentucky
Kentucky · 45121
Office
Unavailable
Facility
$1561.03
No comparable office rate is available.
New Orleans
Louisiana · 45121
Office
Unavailable
Facility
$1639.41
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 45121
Office
Unavailable
Facility
$1570.22
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 45121
Office
Unavailable
Facility
$1724.63
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 45121
Office
Unavailable
Facility
$1616.77
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 45121
Office
Unavailable
Facility
$1736.91
No comparable office rate is available.
Rest Of Maryland
Maryland · 45121
Office
Unavailable
Facility
$1624.14
No comparable office rate is available.
Rest Of Maine
Maine · 45121
Office
Unavailable
Facility
$1500.08
No comparable office rate is available.
Southern Maine
Maine · 45121
Office
Unavailable
Facility
$1532.88
No comparable office rate is available.
Detroit
Michigan · 45121
Office
Unavailable
Facility
$1789.16
No comparable office rate is available.
Rest Of Michigan
Michigan · 45121
Office
Unavailable
Facility
$1625.60
No comparable office rate is available.
Minnesota
Minnesota · 45121
Office
Unavailable
Facility
$1464.29
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 45121
Office
Unavailable
Facility
$1598.25
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 45121
Office
Unavailable
Facility
$1610.17
No comparable office rate is available.
Rest Of Missouri
Missouri · 45121
Office
Unavailable
Facility
$1564.38
No comparable office rate is available.
Mississippi
Mississippi · 45121
Office
Unavailable
Facility
$1504.38
No comparable office rate is available.
Montana**
Montana · 45121
Office
Unavailable
Facility
$1629.79
No comparable office rate is available.
North Carolina
North Carolina · 45121
Office
Unavailable
Facility
$1509.98
No comparable office rate is available.
North Dakota**
North Dakota · 45121
Office
Unavailable
Facility
$1479.71
No comparable office rate is available.
Nebraska
Nebraska · 45121
Office
Unavailable
Facility
$1439.51
No comparable office rate is available.
New Hampshire
New Hampshire · 45121
Office
Unavailable
Facility
$1616.23
No comparable office rate is available.
Northern Nj
New Jersey · 45121
Office
Unavailable
Facility
$1775.97
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 45121
Office
Unavailable
Facility
$1732.31
No comparable office rate is available.
New Mexico
New Mexico · 45121
Office
Unavailable
Facility
$1645.57
No comparable office rate is available.
Nevada**
Nevada · 45121
Office
Unavailable
Facility
$1588.39
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 45121
Office
Unavailable
Facility
$1989.41
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 45121
Office
Unavailable
Facility
$1766.98
No comparable office rate is available.
Queens
New York · 45121
Office
Unavailable
Facility
$1881.19
No comparable office rate is available.
Rest Of New York
New York · 45121
Office
Unavailable
Facility
$1533.51
No comparable office rate is available.
Ohio
Ohio · 45121
Office
Unavailable
Facility
$1594.93
No comparable office rate is available.
Oklahoma
Oklahoma · 45121
Office
Unavailable
Facility
$1527.77
No comparable office rate is available.
Portland
Oregon · 45121
Office
Unavailable
Facility
$1628.26
No comparable office rate is available.
Rest Of Oregon
Oregon · 45121
Office
Unavailable
Facility
$1553.29
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 45121
Office
Unavailable
Facility
$1713.90
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 45121
Office
Unavailable
Facility
$1581.11
No comparable office rate is available.
Puerto Rico
Puerto Rico · 45121
Office
Unavailable
Facility
$1631.22
No comparable office rate is available.
Rhode Island
Rhode Island · 45121
Office
Unavailable
Facility
$1635.10
No comparable office rate is available.
South Carolina
South Carolina · 45121
Office
Unavailable
Facility
$1559.60
No comparable office rate is available.
South Dakota**
South Dakota · 45121
Office
Unavailable
Facility
$1461.97
No comparable office rate is available.
Tennessee
Tennessee · 45121
Office
Unavailable
Facility
$1473.80
No comparable office rate is available.
Austin
Texas · 45121
Office
Unavailable
Facility
$1628.22
No comparable office rate is available.
Beaumont
Texas · 45121
Office
Unavailable
Facility
$1573.61
No comparable office rate is available.
Brazoria
Texas · 45121
Office
Unavailable
Facility
$1578.23
No comparable office rate is available.
Dallas
Texas · 45121
Office
Unavailable
Facility
$1601.10
No comparable office rate is available.
Fort Worth
Texas · 45121
Office
Unavailable
Facility
$1600.10
No comparable office rate is available.
Galveston
Texas · 45121
Office
Unavailable
Facility
$1591.26
No comparable office rate is available.
Houston
Texas · 45121
Office
Unavailable
Facility
$1730.18
No comparable office rate is available.
Rest Of Texas
Texas · 45121
Office
Unavailable
Facility
$1583.78
No comparable office rate is available.
Utah
Utah · 45121
Office
Unavailable
Facility
$1578.65
No comparable office rate is available.
Virginia
Virginia · 45121
Office
Unavailable
Facility
$1548.46
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 45121
Office
Unavailable
Facility
$1631.22
No comparable office rate is available.
Vermont
Vermont · 45121
Office
Unavailable
Facility
$1500.76
No comparable office rate is available.
Rest Of Washington
Washington · 45121
Office
Unavailable
Facility
$1604.80
No comparable office rate is available.
Seattle (King Cnty)
Washington · 45121
Office
Unavailable
Facility
$1728.83
No comparable office rate is available.
Wisconsin
Wisconsin · 45121
Office
Unavailable
Facility
$1436.81
No comparable office rate is available.
West Virginia
West Virginia · 45121
Office
Unavailable
Facility
$1683.25
No comparable office rate is available.
Wyoming**
Wyoming · 45121
Office
Unavailable
Facility
$1564.38
No comparable office rate is available.
See how rates vary across the country
45121 · 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?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, 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 45121 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1764.70
$1604.27 × 110% = $1764.70
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 45121 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,474
- Code
- 45121
- Physician work
- 28.35
- Practice expense
- 12.87
- Malpractice
- 7.59
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 28.35 | × 1.005 | 28.4917 |
| Practice expense | 12.87 | × 0.988 | 12.7156 |
| Malpractice | 7.59 | × 0.899 | 6.8234 |
| Total RVUs | 48.0307 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1604.27
Open 45121 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 28.35 | 1.005 |
| Practice expense | 12.87 | 0.988 |
| Malpractice | 7.59 | 0.899 |
(28.35 × 1.005 + 12.87 × 0.988 + 7.59 × 0.899) × $33.4009 = $1604.27
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
45121 · 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 | $1604.27 | RVU26D |
| 2026-07-01 | Not available in this setting | $1604.27 | RVU26C |
| 2026-04-01 | Not available in this setting | $1604.27 | RVU26B |
| 2026-01-01 | Not available in this setting | $1604.27 | RVU26A |
| 2025-10-01 | Not available in this setting | $1694.17 | RVU25D |
| 2025-07-01 | Not available in this setting | $1694.17 | RVU25C |
| 2025-04-01 | Not available in this setting | $1694.17 | RVU25B |
| 2025-01-01 | Not available in this setting | $1694.17 | RVU25A |
45121 billing questions
How does this differ from 45120?
45121 includes removal of the colon as well as the rectum, with an ileostomy. 45120 describes a rectal resection and does not represent the same complete colorectal removal.
Is the colon removal separately coded?
The combined service is represented by 45121 when the operative report supports the complete resection and ileostomy. Do not separately code the same colon removal as an additional procedure.
How does 45119 differ?
45119 describes a complete resection with an ileoanal reservoir reconstruction. Use 45121 when the documented reconstruction is an ileostomy rather than that reservoir.
What documentation supports 45121?
The operative report should identify removal of both the colon and rectum and document creation of the ileostomy. A rectal-only resection or a partial resection does not support this code.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while team surgery 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 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.
5,47145116,,Partial removal of rectum,A,,27.03,11.20,NA,11.20,,3.89,42.12,42.12,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47245119,,Remove rectum w/reservoir,A,,32.64,13.77,NA,13.77,,4.71,51.12,51.12,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47345120,,Removal of rectum,A,,25.74,12.24,NA,12.24,,6.87,44.85,44.85,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47445121,,Removal of rectum and colon,A,,28.35,12.87,NA,12.87,,7.59,48.81,48.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47545123,,Partial proctectomy,A,,18.39,9.25,NA,9.25,,3.28,30.92,30.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47645126,,Pelvic exenteration,A,,47.87,18.16,NA,18.16,,8.30,74.33,74.33,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47745130,,Excision of rectal prolapse,A,,18.04,8.80,NA,8.80,,3.24,30.08,30.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503