Billing code 45136: Ileoanal pouch excisionMedicare rate & RVUs in Delaware
Removal of a previously constructed ileoanal pouch is reported when the reservoir is excised during operative management of pouch failure or disease.
CMS doesn’t publish an office rate for 45136 in Delaware.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 45136 covers
Code 45136 identifies operative removal of an ileoanal reservoir, or pouch, previously fashioned from ileum and connected to the anal canal, rather than construction of a new pouch. Colorectal surgeons may perform the operation for a failed or diseased pouch, including persistent inflammatory or septic complications or unacceptable pouch function. It is performed in an operating room, generally in a hospital or other surgical facility. The operative report should establish that an existing ileoanal reservoir was excised and describe the indication and extent of the work; rectal excision alone is not enough to support this code.
Report the service for the pouch excision documented, distinguishing it from initial pouch-forming surgery and other rectal resections. This major operation has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this anatomy.
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.
45136 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,619.58 |
How the 45136 rate is calculated
Each of 45136’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45136
RVUs × geographic indexes × conversion factor
Work30.05
30.05 RVUs× 1.000 GPCI
Practice expense14.58
14.58 RVUs× 1.000 GPCI
Malpractice4.32
4.32 RVUs× 1.000 GPCI
Adjusted RVUs
48.9500
Conversion factor
$33.4009
Medicare rate
$1,634.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45136
45136 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45136
Ileoanal pouch excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 45136
Ileoanal pouch excision
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45136 without 51 · national facility
$1,634.97
Ileoanal pouch excision
45136-51 · Second procedure: 50%
$817.49
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45136 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45119Proctectomy
- 45119 describes surgery that creates an ileoanal reservoir during proctectomy. Use 45136 when the operation removes an already constructed reservoir.
- 45110Rectal resection
- 45110 represents complete rectal removal. Choose 45136 when the operative service is excision of an existing ileoanal pouch, rather than a complete proctectomy.
- 45111Partial proctectomy
- 45111 represents partial proctectomy. It is not the pouch-excision code when the operative report documents removal of a previously constructed ileoanal reservoir.
45136 billing questions
How is pouch excision different from pouch construction?
Report 45136 for excision of an existing ileoanal reservoir. Code 45119 is the related option for an operation that constructs an ileoanal reservoir.
What documentation supports 45136?
The operative report should identify the previously created ileoanal reservoir, confirm its excision, and describe the indication and extent of the operation.
Does the 90-day global include postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
How are multiple procedures handled in the same session?
The highest-valued procedure is paid in full, and the other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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