No office rate
Both address a rectum-to-bladder fistula. Choose 45805 when the operative service includes colostomy; 45800 represents repair without that service.
On this page
CMS RVU26D · Effective 2026-10-01
45800 Fistula repair Medicare reimbursement rates in Connecticut
Surgical closure of a communication between the rectum and urinary bladder, reported when operative repair is performed without the colostomy service represented by its sibling code. Compare 45800 office and facility rates across CMS payment localities in Connecticut.
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 45800 in Connecticut?
Connecticut 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
$1288.38
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 45800: Rectovesical fistula repair
Surgical closure of a communication between the rectum and urinary bladder, reported when operative repair is performed without the colostomy service represented by its sibling code.
Code 45800 represents operative repair of a fistulous tract connecting the rectum with the urinary bladder. A colorectal or urologic surgeon typically performs the procedure in a hospital operating room. Patients may present with recurrent urinary infections, pneumaturia, or fecal material in the urine; the operative findings and documented tract establish the anatomy being repaired. The repair may be part of treatment for disease or injury affecting the pelvic organs.
Select this service when the operative report documents rectum-to-bladder repair without the colostomy service represented by 45805. The record should identify the fistula site and describe the repair performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this repair. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45800
- 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 RVU19.80 · 55%
- Practice expense (office) RVU11.12 · 31%
- Malpractice RVU5.29 · 15%
41
Medicare services in 2024 · #5485 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.
45800 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
45820 addresses a rectum-to-urethra fistula. Choose 45800 when the tract connects the rectum to the bladder.
No office rate
45825 addresses rectourethral fistula repair with colostomy. The fistula site is urethral, not bladder, as with 45800.
Compare 45800 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$1288.38
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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 45800 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,560
- Code
- 45800
- Physician work
- 19.80
- Practice expense
- 11.12
- Malpractice
- 5.29
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.80 | × 1.020 | 20.1960 |
| Practice expense | 11.12 | × 1.077 | 11.9762 |
| Malpractice | 5.29 | × 1.210 | 6.4009 |
| Total RVUs | 38.5731 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1288.38
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.8 | 1.02 |
| Practice expense | 11.12 | 1.077 |
| Malpractice | 5.29 | 1.21 |
(19.8 × 1.02 + 11.12 × 1.077 + 5.29 × 1.21) × $33.4009 = $1288.38
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.
45800 billing questions
How does 45800 differ from 45805?
45800 represents rectum-to-bladder fistula repair without the colostomy service represented by 45805. Check the operative report for whether the repair included colostomy.
When would 45820 be more appropriate?
Use 45820 when the fistula connects the rectum with the urethra rather than the bladder. The documented anatomy, not the symptoms alone, distinguishes the codes.
Can modifier 50 be used?
No. Modifier 50 is not appropriate for this repair; the service is not a bilateral procedure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; 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.
5,5574561F,,Pt w/ coronary artery stent,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
5,5584562F,,Pt w/o coronary artery stent,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
5,5594563F,,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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808