Billing code 45397: ProctectomyMedicare rate & RVUs in Georgia
Reports laparoscopic complete proctectomy with creation of an ileal pouch and connection to the anus, with or without a diverting ileostomy.
CMS doesn’t publish an office rate for 45397 in Georgia.
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 45397 covers
A colorectal surgeon uses a laparoscopic approach to remove the rectum and create an ileal reservoir, typically an S- or J-shaped pouch, connected to the anus. This restorative operation may be performed for conditions such as ulcerative colitis or familial adenomatous polyposis. A diverting ileostomy may also be created to protect the pouch connection; it is included in the service when performed.
Select this code when the operative report supports laparoscopic complete proctectomy, ileal pouch construction, and ileoanal anastomosis. The pouch and anastomosis distinguish it from laparoscopic proctectomy with colostomy. The service has a 90-day global period, including 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 others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this unpaired 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.
Where 45397 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $1,995.61 |
| Rest Of Georgia | Unavailable | $1,922.31 |
How the 45397 rate is calculated
Each of 45397’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 · 45397
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 35.59Practice expense 16.39Malpractice 6.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45397
45397 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45397
Proctectomy
| 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 · 45397
Proctectomy
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
45397 without 51 · national facility
$1,941.93
Proctectomy
45397-51 · Second procedure: 50%
$970.97
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%).
45397 compared with similar codes
Compare codes
45397 vs 45395 vs 45113 vs 44212: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45395Rectal resection
- Choose 45397 when the laparoscopic operation creates an ileal pouch with an ileoanal connection. Choose 45395 for laparoscopic proctectomy with colostomy instead.
- 45113Partial proctectomy
- 45113 describes the open approach to complete proctectomy with ileal pouch reconstruction; 45397 describes the laparoscopic approach.
- 44212Proctocolectomy
- 44212 is for laparoscopic total colectomy with proctectomy and ileal pouch reconstruction. Use 45397 when the documented procedure is proctectomy with pouch creation rather than total colectomy.
45397 billing questions
How does this differ from 45395?
45397 includes creation of an ileal pouch and an ileoanal connection. 45395 describes laparoscopic proctectomy with colostomy rather than pouch reconstruction.
Is a diverting ileostomy included?
Yes. The service includes a diverting ileostomy when performed, so its presence does not change the choice of 45397.
What operative details support 45397?
Document the laparoscopic approach, complete rectal removal, ileal reservoir construction, and ileoanal anastomosis. Note whether a diverting ileostomy was created.
Can modifier 50 be used?
No. The procedure involves unpaired anatomy, so modifier 50 is inappropriate.
How are multiple 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 is the postoperative global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
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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