Billing code 45112: Rectal removalMedicare rate & RVUs in Guam
Reports complete rectal removal through an abdominal and perineal operation, with colostomy and pelvic lymph node dissection, commonly for rectal cancer.
CMS doesn’t publish an office rate for 45112 in Guam.
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 45112 covers
This operation removes the rectum through abdominal and perineal access, creates a colostomy, and includes pelvic lymph node dissection. Colorectal or general surgeons commonly perform it in a hospital for rectal cancer requiring this extent of resection. The operative report should establish the complete rectal resection, the colostomy, and the lymph node dissection; a limited rectal resection or a procedure using a different reconstruction belongs to a different code pathway.
CMS assigns 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 other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted. Modifier 50 is inappropriate for this operation.
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.
45112 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,630.54 |
How the 45112 rate is calculated
Each of 45112’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 · 45112
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 32.35Practice expense 12.11Malpractice 4.66
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45112
45112 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45112
Rectal removal
| 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 · 45112
Rectal removal
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
45112 without 51 · national facility
$1,640.65
Rectal removal
45112-51 · Second procedure: 50%
$820.33
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%).
45112 compared with similar codes
Compare codes
45112 vs 45110 vs 45111 vs 45119 vs 45121: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45110Rectal resection
- Both describe complete rectal removal with colostomy, but 45112 includes pelvic lymph node dissection. Choose 45110 when that dissection is not performed.
- 45111Partial proctectomy
- 45111 describes partial rectal removal with anastomosis. 45112 is for complete removal with colostomy and pelvic lymph node dissection.
- 45119Proctectomy
- 45119 uses an ileal reservoir reconstruction; 45112 includes colostomy creation and pelvic lymph node dissection.
- 45121Proctocolectomy
- 45121 includes removal of colon as well as rectum. 45112 describes complete rectal removal with colostomy and pelvic lymph node dissection.
45112 billing questions
How does 45112 differ from 45110?
45112 includes pelvic lymph node dissection with the complete rectal resection and colostomy. Use 45110 when that additional dissection is not performed.
Can 45112 be reported for a partial rectal resection?
No. This code represents complete rectal removal; partial resections with anastomosis are represented by other codes, such as 45111.
What operative documentation supports 45112?
The report should describe complete rectal removal, colostomy creation, and pelvic lymph node dissection, along with the abdominal and perineal operative work.
Can an assistant surgeon be paid for 45112?
CMS permits assistant-at-surgery payment for this code. Co-surgeon payment requires supporting documentation.
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.
Should modifier 50 be used?
No. Modifier 50 is inappropriate for this operation.
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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