No office rate
45100 is rectal biopsy for tissue sampling. Choose 45190 when the service performed is destruction of the tumor.
On this page
CMS RVU26D · Effective 2026-10-01
45190 Rectal tumor destruction Medicare reimbursement rates in Alabama
Reports destruction of a rectal tumor using a method such as electrosurgery or cryosurgery, rather than removal by excision. Compare 45190 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 45190 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$615.77
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Colorectal surgery
About 45190: Rectal tumor destruction procedure
Reports destruction of a rectal tumor using a method such as electrosurgery or cryosurgery, rather than removal by excision.
A surgeon destroys a tumor located in the rectum, using a method such as electrosurgery or cryosurgery. The service is typically performed by a colorectal or general surgeon in an operating room or other procedural setting. It describes treatment by destruction, not removal of the tumor through an excision approach.
Report the service when the operative documentation identifies the rectal tumor and the destruction technique. The 90-day global period includes 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 multiple-procedure reduction. Modifier 50 is inappropriate for this rectal service. Medicare does not pay an assistant at surgery; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 45190
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.16 · 50%
- Practice expense (office) RVU8.52 · 42%
- Malpractice RVU1.45 · 7%
296
Medicare services in 2024 · #4000 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.
45190 compared with similar codes
Office rates for Alabama, from the same CMS release.
45160
No office rateRectal lesion excision
45160 describes transanal excision of a rectal lesion, including muscularis propria; 45190 describes destruction rather than excision.
No office rate
45171 is transanal partial-thickness excision of a rectal tumor. Use 45190 for destruction, not partial-thickness removal.
No office rate
45172 is transanal full-thickness excision of a rectal tumor. Use 45190 when the tumor is destroyed instead of excised.
Compare 45190 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$615.77
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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 45190 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,484
- Code
- 45190
- Physician work
- 10.16
- Practice expense
- 8.52
- Malpractice
- 1.45
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.16 | × 1.000 | 10.1600 |
| Practice expense | 8.52 | × 0.875 | 7.4550 |
| Malpractice | 1.45 | × 0.566 | 0.8207 |
| Total RVUs | 18.4357 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$615.77
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.16 | 1 |
| Practice expense | 8.52 | 0.875 |
| Malpractice | 1.45 | 0.566 |
(10.16 × 1 + 8.52 × 0.875 + 1.45 × 0.566) × $33.4009 = $615.77
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.
45190 billing questions
How is destruction different from transanal excision?
Use 45190 when the tumor is destroyed. Codes 45171 and 45172 describe transanal excision, with the distinction based on partial- versus full-thickness removal.
Can a rectal biopsy be reported instead of 45190?
45100 describes biopsy for tissue sampling. It is not a substitute for a documented procedure that destroys the tumor.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this rectal tumor service.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
What documentation supports 45190?
Document the rectal tumor treated and the method used to destroy it. The record should distinguish destruction from biopsy or excision.
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.
5,48145160,,Excision of rectal lesion,A,,15.92,9.06,NA,9.06,,4.25,29.23,29.23,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48245171,,Exc rect tum transanal part,A,,7.93,8.83,NA,8.83,,1.56,18.32,18.32,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48345172,,Exc rect tum transanal full,A,,11.83,9.81,NA,9.81,,2.16,23.80,23.80,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48445190,,Destruction rectal tumor,A,,10.16,8.52,NA,8.52,,1.45,20.13,20.13,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,4854525F,,Neuropsychia interven order,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
5,4864526F,,Neuropsychia interven rcvd,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
5,48745300,,Proctosigmoidoscopy dx,A,,0.78,3.54,,0.44,,0.13,4.45,1.35,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515