Billing code 45500: Rectal injury repairMedicare rate & RVUs in Guam
Surgical proctoplasty repairs an injury to the rectum, including anorectal sphincter repair when needed, during an operative encounter.
CMS doesn’t publish an office rate for 45500 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 45500 covers
This operation repairs an injured rectum through a proctoplasty approach; the repair may also involve the anorectal sphincter when that structure is injured. It is typically performed by a colorectal or general surgeon in an operating room for a rectal injury requiring operative repair. The operative report should identify the injury and describe the repair performed, including any sphincter repair.
Report 45500 when the documented service is injury-related proctoplasty, rather than reconstruction for rectal narrowing or repair through a different operative approach. The Medicare global period includes 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 multiple procedure reduction. Assistant-at-surgery payment requires documentation of medical necessity.
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.
45500 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $576.30 |
How the 45500 rate is calculated
Each of 45500’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 · 45500
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.54Practice expense 7.52Malpractice 2.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45500
45500 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45500
Rectal injury repair
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 45500
Rectal injury repair
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
45500 without 51 · national facility
$570.15
Rectal injury repair
45500-51 · Second procedure: 50%
$285.08
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%).
45500 compared with similar codes
Compare codes
45500 vs 45505 vs 45562 vs 45563: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45505Rectal repair
- Choose 45500 for injury-related proctoplasty; 45505 is for proctoplasty to address rectal stenosis.
- 45562Rectal injury repair
- 45562 describes transabdominal exploration and repair of a rectal injury. Use 45500 when the documented operation is the injury-related proctoplasty.
- 45563Rectal repair
- 45563 describes transabdominal exploration and rectal injury repair with a colostomy. 45500 represents injury-related proctoplasty instead.
45500 billing questions
How does 45500 differ from 45505?
45500 is for proctoplasty to repair an injury. 45505 is the related proctoplasty code for treatment of rectal stenosis.
When is 45562 a better fit?
Consider 45562 when the documented service is transabdominal exploration and repair of a rectal injury, rather than the proctoplasty represented by 45500.
Are related postoperative visits separately reported?
The day-before preoperative visit and 90 days of related postoperative care are included in the 90-day global period.
When can an assistant at surgery be reported?
Medicare assistant-at-surgery payment requires documentation that the assistant was medically necessary.
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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