Billing code 45190: Rectal tumor destructionMedicare rate & RVUs in Illinois
Reports destruction of a rectal tumor using a method such as electrosurgery or cryosurgery, rather than removal by excision.
CMS doesn’t publish an office rate for 45190 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 45190 covers
A surgeon destroys a tumor located in the rectum, using a method such as electrosurgery or cryosurgery. The service is typically performed by a colorectal or general surgeon in an operating room or other procedural setting. It describes treatment by destruction, not removal of the tumor through an excision approach.
Report the service when the operative documentation identifies the rectal tumor and the destruction technique. 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 other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this rectal service. Medicare does not pay an assistant at surgery; co-surgeons are paid only with 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 45190 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 | $738.88 |
| East St. Louis | Unavailable | $698.70 |
| Rest Of Illinois | Unavailable | $674.87 |
| Suburban Chicago | Unavailable | $719.81 |
How the 45190 rate is calculated
Each of 45190’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 · 45190
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.16Practice expense 8.52Malpractice 1.45
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45190
45190 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45190
Rectal tumor destruction
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 45190
Rectal tumor destruction
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
45190 without 51 · national facility
$672.36
Rectal tumor destruction
45190-51 · Second procedure: 50%
$336.18
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%).
45190 compared with similar codes
Compare codes
45190 vs 45100 vs 45160 vs 45171 vs 45172: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45100Rectal biopsy
- 45100 is rectal biopsy for tissue sampling. Choose 45190 when the service performed is destruction of the tumor.
- 45160Rectal lesion excision
- 45160 describes transanal excision of a rectal lesion, including muscularis propria; 45190 describes destruction rather than excision.
- 45171Rectal tumor excision
- 45171 is transanal partial-thickness excision of a rectal tumor. Use 45190 for destruction, not partial-thickness removal.
- 45172Rectal tumor excision
- 45172 is transanal full-thickness excision of a rectal tumor. Use 45190 when the tumor is destroyed instead of excised.
45190 billing questions
How is destruction different from transanal excision?
Use 45190 when the tumor is destroyed. Codes 45171 and 45172 describe transanal excision, with the distinction based on partial- versus full-thickness removal.
Can a rectal biopsy be reported instead of 45190?
45100 describes biopsy for tissue sampling. It is not a substitute for a documented procedure that destroys the tumor.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this rectal tumor service.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
What documentation supports 45190?
Document the rectal tumor treated and the method used to destroy it. The record should distinguish destruction from biopsy or excision.
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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