Billing code 45905: Anal dilationMedicare rate & RVUs in Guam
Reports procedural dilation of the anal sphincter, commonly to relieve sphincter tightness associated with an anal fissure.
CMS doesn’t publish an office rate for 45905 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 45905 covers
A colorectal or general surgeon dilates the anal sphincter to relieve tightness or spasm, often in a patient with an anal fissure. The procedure addresses the sphincter itself; it is distinct from dilation directed at a narrowing higher in the rectum. It may be performed in a procedural setting or operating room, depending on the patient and technique.
Report the service when the record supports actual sphincter dilation and identifies the indication and the structure treated. Document the relevant examination findings and the procedure performed; an evaluation or examination alone does not establish that dilation occurred. CMS assigns a 10-day global period, so related postoperative visits during that period are included. 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% multiple-procedure reduction. The anatomy is not suited to modifier 50. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
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.
45905 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $173.86 |
How the 45905 rate is calculated
Each of 45905’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 · 45905
RVUs × geographic indexes × conversion factor
Work2.29
2.29 RVUs× 1.000 GPCI
Practice expense2.35
2.35 RVUs× 1.000 GPCI
Malpractice0.42
0.42 RVUs× 1.000 GPCI
Adjusted RVUs
5.0600
Conversion factor
$33.4009
Medicare rate
$169.01
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45905
45905 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45905
Anal dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 45905
Anal dilation
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45905 without 51 · national facility
$169.01
Anal dilation
45905-51 · Second procedure: 50%
$84.51
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%).
45905 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45910Rectal dilation
- Choose 45905 for dilation of the anal sphincter; choose 45910 when the treated site is a rectal narrowing.
- 46080Anal sphincterotomy
- 45905 describes dilation of the anal sphincter. 46080 describes lateral sphincterotomy, a separate operative treatment for an anal fissure.
- 46200Fissure surgery
- 45905 is sphincter dilation; 46200 is fissurectomy, with sphincterotomy when performed. The documented procedure, not the fissure diagnosis alone, determines the code.
45905 billing questions
When is 45905 appropriate for a patient with an anal fissure?
Use it when the documented procedure dilates the anal sphincter, such as to address fissure-associated tightness or spasm. A fissure diagnosis by itself does not show that sphincter dilation was performed.
How is 45905 different from 45910?
45905 treats the anal sphincter. 45910 is for dilation directed at a rectal narrowing, so select based on the structure actually dilated.
Does 45905 have a postoperative global period?
Yes. CMS assigns a 10-day global period, which includes related postoperative visits during that period.
Can modifier 50 be used for 45905?
No. The anatomy and service do not support bilateral reporting with modifier 50.
How does Medicare handle 45905 when another procedure is performed in the same session?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Medicare does not pay an assistant at surgery; co-surgeons and team surgeons are 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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