No office rate
Choose 45541 for a perineal repair; 45540 describes an abdominal approach.
On this page
CMS RVU26D · Effective 2026-10-01
45541 Prolapse repair Medicare reimbursement rates in Hawaii
Reports operative correction of rectal prolapse through a perineal approach, such as a Delorme-type repair performed by a colorectal or general surgeon. Compare 45541 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 45541 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$891.97
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Colorectal surgery
About 45541: Perineal rectal prolapse repair
Reports operative correction of rectal prolapse through a perineal approach, such as a Delorme-type repair performed by a colorectal or general surgeon.
CPT 45541 describes surgical correction of rectal prolapse through the perineum rather than through an abdominal approach. A colorectal or general surgeon may perform a Delorme-type operation, which can involve removing a sleeve of rectal mucosa and plicating the underlying muscle. The service is generally performed in an operating room for a patient with prolapse extending through the anus; the operative report should identify the perineal route and the corrective work performed.
Report the code when the documented operation matches perineal repair, not abdominal rectopexy or a distinct prolapse excision procedure. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this operation.
CMS billing rules for 45541
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.48 · 54%
- Practice expense (office) RVU9.26 · 35%
- Malpractice RVU2.93 · 11%
215
Medicare services in 2024 · #4263 by national volume
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.
45541 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
45550 describes abdominal prolapse repair with sigmoid resection. It is not the perineal repair represented by 45541.
No office rate
45130 represents perineal excision of rectal prolapse. Use 45541 when the documented service is repair rather than that excision procedure.
No office rate
45400 describes laparoscopic abdominal repair, while 45541 is for repair performed through a perineal approach.
Compare 45541 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$891.97
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45541 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,545
- Code
- 45541
- Physician work
- 14.48
- Practice expense
- 9.26
- Malpractice
- 2.93
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.48 | × 1.000 | 14.4800 |
| Practice expense | 9.26 | × 1.137 | 10.5286 |
| Malpractice | 2.93 | × 0.579 | 1.6965 |
| Total RVUs | 26.7051 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$891.97
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.48 | 1 |
| Practice expense | 9.26 | 1.137 |
| Malpractice | 2.93 | 0.579 |
(14.48 × 1 + 9.26 × 1.137 + 2.93 × 0.579) × $33.4009 = $891.97
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
45541 billing questions
How is 45541 distinguished from 45540?
45541 is for correction through a perineal route. Use 45540 for an abdominal approach to rectal prolapse.
Does a Delorme-type repair fit 45541?
Yes, a Delorme-type perineal repair is a representative procedure. The operative note should establish the perineal approach and the corrective work performed.
Is modifier 50 appropriate?
No. The anatomy and service descriptor make modifier 50 inappropriate for this procedure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures performed in the same session are subject to the standard multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,5424552F,,Pt ref for speech lang path,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5434553F,,Pt asst re end life issues,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,54445540,,Correct rectal prolapse,A,,17.67,8.32,NA,8.32,,3.18,29.17,29.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,54545541,,Correct rectal prolapse,A,,14.48,9.26,NA,9.26,,2.93,26.67,26.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5464554F,,Pt recvd inhal anesthetic,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,54745550,,Repair rectum/remove sigmoid,A,,24.18,11.73,NA,11.73,,4.58,40.49,40.49,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5484555F,,Pt recvd no inhal anesthic,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014