$340.41
Use 45331 when a flexible sigmoidoscope is used to obtain the biopsy. Use 45100 for tissue sampling through transanal surgical access.
On this page
CMS RVU26D · Effective 2026-10-01
45100 Rectal biopsy Medicare reimbursement rates in Colorado
Transanal rectal biopsy obtains tissue for diagnosis, including evaluation of suspected Hirschsprung disease when a surgical tissue sample is needed. Compare 45100 office and facility rates across CMS payment localities in Colorado.
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 45100 in Colorado?
Colorado 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
$307.41
1 of 1 localities have a supported rate.
Payment area: Colorado
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 45100: Transanal rectal tissue biopsy
Transanal rectal biopsy obtains tissue for diagnosis, including evaluation of suspected Hirschsprung disease when a surgical tissue sample is needed.
A surgeon reaches the rectum through the anus and removes tissue for pathologic examination. A common use is obtaining an adequate rectal sample when evaluating suspected Hirschsprung disease; colorectal, general, or pediatric surgeons may perform the procedure in an operating room or ambulatory surgery setting. This is distinct from taking a biopsy through a flexible endoscope.
Report the transanal biopsy when the operative record supports surgical access and tissue sampling from the rectum. Document the indication, approach, biopsy site, and specimens submitted for pathology. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For other procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 45100
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.94 · 44%
- Practice expense (office) RVU4.33 · 48%
- Malpractice RVU0.78 · 9%
1.8K
Medicare services in 2024 · #2552 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.
45100 compared with similar codes
Office rates for Colorado, from the same CMS release.
$500.69
Use 45380 for biopsy performed during colonoscopy. The defining distinction is endoscopic access rather than transanal surgical access.
45160
No office rateRectal lesion excision
45160 describes transanal excision of a rectal lesion; 45100 describes obtaining biopsy tissue rather than excising the lesion.
Compare 45100 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
Colorado →
Office / nonfacility
Unavailable
Facility
$307.41
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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 45100 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
5,463
- Code
- 45100
- Physician work
- 3.94
- Practice expense
- 4.33
- Malpractice
- 0.78
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.94 | × 1.012 | 3.9873 |
| Practice expense | 4.33 | × 1.064 | 4.6071 |
| Malpractice | 0.78 | × 0.781 | 0.6092 |
| Total RVUs | 9.2036 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$307.41
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.94 | 1.012 |
| Practice expense | 4.33 | 1.064 |
| Malpractice | 0.78 | 0.781 |
(3.94 × 1.012 + 4.33 × 1.064 + 0.78 × 0.781) × $33.4009 = $307.41
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.
45100 billing questions
How does this differ from an endoscopic rectal biopsy?
This code describes tissue sampling through transanal surgical access. A biopsy taken through a flexible sigmoidoscope or colonoscope is reported with the applicable endoscopy code instead.
Is this the usual code for a rectal biopsy to evaluate suspected Hirschsprung disease?
It can describe a transanal surgical biopsy obtained for that evaluation. The operative note should establish the transanal approach and rectal tissue sampling.
Can modifier 50 be used for biopsies on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not append modifier 50.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. The surgeon's documentation should distinguish care related to the biopsy from unrelated services.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard 50% multiple-procedure reduction.
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.
5,46045005,,Drainage of rectal abscess,A,,1.97,8.50,,2.72,,0.51,10.98,5.20,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,4614500F,,Ref to outpt card rehab prog,M,,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
5,46245020,,Drainage of rectal abscess,A,,8.35,6.54,NA,6.54,,1.63,16.52,16.52,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,46345100,,Biopsy of rectum,A,,3.94,4.33,NA,4.33,,0.78,9.05,9.05,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,46445108,,Anorectal myomectomy,A,,4.99,4.84,NA,4.84,,1.33,11.16,11.16,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,4654510F,,Prev cardrehab qualcardevent,M,,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
5,46645110,,Removal of rectum,A,,29.99,14.55,NA,14.55,,5.53,50.07,50.07,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
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