Billing code 45111: Partial proctectomyMedicare rate & RVUs in Illinois
Reports abdominal removal of part of the rectum with bowel reconnection, typically for rectal disease when the operative plan includes an anastomosis.
CMS doesn’t publish an office rate for 45111 in Illinois.
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 45111 covers
A colorectal surgeon removes a segment of rectum through an abdominal approach and reconnects the remaining bowel with an anastomosis. The operation may be performed for rectal cancer or selected benign disease when the surgical plan preserves bowel for reconstruction. It is generally performed in a hospital or other facility setting. This code represents a segmental rectal resection with reconnection, not a limited transanal excision of a rectal lesion.
Select the code from the operative report, which should support the partial resection, abdominal approach, and anastomosis. The 90-day 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 others at 50%. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is 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.
Where 45111 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,173.34 |
| East St. Louis | Unavailable | $1,109.42 |
| Rest Of Illinois | Unavailable | $1,052.62 |
| Suburban Chicago | Unavailable | $1,116.60 |
How the 45111 rate is calculated
Each of 45111’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 · 45111
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.56Practice expense 9.07Malpractice 3.63
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45111
45111 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45111
Partial 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 · 45111
Partial 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
45111 without 51 · national facility
$1,010.71
Partial proctectomy
45111-51 · Second procedure: 50%
$505.36
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%).
45111 compared with similar codes
Compare codes
45111 vs 45110 vs 45113 vs 45171 vs 45172: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45110Rectal resection
- 45111 is for partial rectal resection with anastomosis through an abdominal approach; 45110 represents complete rectal removal.
- 45113Partial proctectomy
- Both describe partial proctectomy with anastomosis, but the operative approach determines which code fits.
- 45171Rectal tumor excision
- 45171 is for transanal partial-thickness excision of a rectal tumor, not abdominal resection of a rectal segment with anastomosis.
- 45172Rectal tumor excision
- 45172 describes transanal full-thickness tumor excision; 45111 describes partial rectal resection through an abdominal approach with bowel reconnection.
45111 billing questions
How is this code distinguished from complete proctectomy?
This code describes removal of part of the rectum with an anastomosis through an abdominal approach. A complete rectal removal is represented by a different proctectomy code.
Can a transanal rectal tumor excision be reported instead?
Use a transanal excision code when the surgeon removes a localized tumor through the anus rather than performing an abdominal segmental rectal resection with anastomosis.
What operative details support reporting this code?
The operative report should establish that part of the rectum was removed through an abdominal approach and that the bowel was reconnected with an anastomosis.
Does the code include postoperative visits?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures subject to the standard multiple procedure reduction are paid at 50%.
May an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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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