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CMS RVU26D · Effective 2026-10-01

45563 Rectal repair Medicare reimbursement rates in Arizona

Reports operative exploration and repair of the rectum performed with colostomy creation, such as in selected congenital rectal conditions or rectal injuries. Compare 45563 office and facility rates across CMS payment localities in Arizona.

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 45563 in Arizona?

Arizona 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

$1521.92

1 of 1 localities have a supported rate.

Payment area: Arizona

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.

Find 45563 in your payment locality →

Colorectal surgery

About 45563: Rectal exploration and repair with colostomy

Reports operative exploration and repair of the rectum performed with colostomy creation, such as in selected congenital rectal conditions or rectal injuries.

A colorectal or general surgeon uses this service when operative exploration and rectal repair are performed together with creation of a colostomy. A congenital anorectal condition, such as imperforate anus, is a representative clinical context; the exact operative plan depends on the anatomy and findings. This is generally an operating-room service rather than an office procedure.

Report the code when the operative record supports both rectal exploration and repair and colostomy creation as part of the operation. The 90-day global package includes the day-before preoperative visit and related postoperative care through day 90. 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted. Report this as a single rectal operation, not a bilateral procedure using modifier 50.

CMS billing rules for 45563

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 RVU25.72 · 55%
  • Practice expense (office) RVU14.42 · 31%
  • Malpractice RVU6.86 · 15%

19

Medicare services in 2024 · #5948 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.

45563 compared with similar codes

Office rates for Arizona, from the same CMS release.

45562

Rectal injury repair

Transabdominal exploration

No office rate

45563 includes colostomy creation with rectal exploration and repair. 45562 is the related exploration-and-repair service without that colostomy component.

45500

Rectal injury repair

Injury-related proctoplasty

No office rate

45500 describes a rectal repair service; choose 45563 when the documented operation also includes rectal exploration and colostomy creation.

45520

Rectal prolapse treatment

Local treatment, any method

$163.74

45520 is for treatment of rectal prolapse. 45563 concerns exploration and repair of the rectum with colostomy creation.

Compare 45563 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

Office and facility base rates · shared scale starting at $0

  • Arizona →

    Office / nonfacility

    Unavailable

    Facility

    $1521.92

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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 45563 in Arizona.

PPRRVU2026_Oct_nonQPP.csv

5,551

Code
45563
Physician work
25.72
Practice expense
14.42
Malpractice
6.86

GPCI2026.csv

6

Locality
Arizona
Physician work
1.000
Practice expense
0.969
Malpractice
0.856
Facility calculation for 45563 in Arizona
ComponentRVULocality factorAdjusted
Physician work25.72× 1.00025.7200
Practice expense14.42× 0.96913.9730
Malpractice6.86× 0.8565.8722
Total RVUs45.5651
Conversion factor× 33.4009

Facility rate, Arizona$1521.92

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work25.721
Practice expense14.420.969
Malpractice6.860.856

(25.72 × 1 + 14.42 × 0.969 + 6.86 × 0.856) × $33.4009 = $1521.92

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.

45563 billing questions

How is 45563 distinguished from 45562?

45563 describes rectal exploration and repair performed with colostomy creation. Use 45562 when exploration and repair are performed without the colostomy component described by 45563.

Can the colostomy be reported separately?

The colostomy is part of the service described by 45563. Review the operative report to confirm that both the rectal work and colostomy creation were performed.

What documentation supports 45563?

The operative report should describe the rectal exploration, the repair performed, and creation of the colostomy. Include the clinical condition and relevant operative findings.

Can modifier 50 be used?

No. Report the rectal operation as a single procedure; modifier 50 is inappropriate for this service.

How are other same-session procedures handled?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team-surgery billing 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.

RVUs for 45563PPRRVU2026_Oct_nonQPP.csv, line 5,551 (RVU26D)
Geographic factors for ArizonaGPCI2026.csv, line 6 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet