No office rate
Choose 45540 for repair of rectal prolapse through an abdominal approach; this code describes local treatment rather than that formal repair.
On this page
CMS RVU26D · Effective 2026-10-01
45520 Rectal prolapse treatment Medicare reimbursement rates in Illinois
Reports a local treatment for rectal prolapse, such as injection therapy, rather than a formal abdominal or perineal prolapse repair. Compare 45520 office and facility rates across CMS payment localities in Illinois.
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 45520 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$157.09–$174.61
4 of 4 localities have a supported rate.
Facility setting
$37.55–$40.98
4 of 4 localities have a supported rate.
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.
Where 45520 pays more and less in Illinois
4 payment localities
$157.09 to $174.61
Colorectal surgery
About 45520: Local treatment of rectal prolapse
Reports a local treatment for rectal prolapse, such as injection therapy, rather than a formal abdominal or perineal prolapse repair.
This service covers a treatment directed at rectal prolapse without the formal abdominal or perineal repair described by the related repair codes. A colorectal or general surgeon may perform a local treatment, such as injection therapy, in an outpatient setting. The record should identify the prolapse and the treatment method performed so the service can be distinguished from repair of the rectum or surgery to correct prolapse through an abdominal or perineal approach.
Report the service based on the treatment actually performed, not simply the diagnosis of prolapse. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 45520
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.54 · 11%
- Practice expense (office) RVU4.44 · 88%
- Malpractice RVU0.07 · 1%
186
Medicare services in 2024 · #4382 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.
45520 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
Choose 45541 when the prolapse is repaired through a perineal approach. This code is for local treatment, not that approach-specific repair.
No office rate
45550 describes abdominal prolapse repair that includes sigmoid resection. This code does not represent that combined repair.
Compare 45520 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$172.57
Facility
$40.98
East St. Louis →
Office / nonfacility
$159.18
Facility
$38.72
Rest Of Illinois →
Office / nonfacility
$157.09
Facility
$37.55
Suburban Chicago →
Office / nonfacility
$174.61
Facility
$40.14
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45520 billing questions
When should this code be chosen over a prolapse repair code?
Use it for a local treatment, such as injection therapy, rather than a formal abdominal or perineal repair. Select a repair code when the operative service matches that approach and repair.
What documentation supports reporting this service?
Document the rectal prolapse, the method used to treat it, and the work performed. The record should make clear that the service was not an abdominal or perineal repair.
Is same-day care included in the service?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can modifier 50 or an assistant-at-surgery claim be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
How is this code affected when another procedure is 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.
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.
5,53845505,,Repair of rectum,A,,8.15,8.18,NA,8.18,,1.46,17.79,17.79,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5394550F,,Noninvas resp support talk,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
5,5404551F,,Nutritional support offered,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
5,54145520,,Treatment of rectal prolapse,A,,0.54,4.44,,0.52,,0.07,5.05,1.13,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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