No office rate
Choose 45905 for dilation of the anal sphincter; choose 45910 when the treated site is a rectal narrowing.
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CMS RVU26D · Effective 2026-10-01
45905 Anal dilation Medicare reimbursement rates in Illinois
Reports procedural dilation of the anal sphincter, commonly to relieve sphincter tightness associated with an anal fissure. Compare 45905 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 45905 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
No supported rate
Facility setting
$170.08–$188.10
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 45905 pays more and less in Illinois
Anorectal procedure
About 45905: Anal sphincter dilation
Reports procedural dilation of the anal sphincter, commonly to relieve sphincter tightness associated with an anal fissure.
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.
CMS billing rules for 45905
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- 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 RVU2.29 · 45%
- Practice expense (office) RVU2.35 · 46%
- Malpractice RVU0.42 · 8%
336
Medicare services in 2024 · #3899 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.
45905 compared with similar codes
Office rates for Illinois, from the same CMS release.
$305.96–$338.49
45905 describes dilation of the anal sphincter. 46080 describes lateral sphincterotomy, a separate operative treatment for an anal fissure.
$507.76–$559.48
45905 is sphincter dilation; 46200 is fissurectomy, with sphincterotomy when performed. The documented procedure, not the fissure diagnosis alone, determines the code.
Compare 45905 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
Unavailable
Facility
$188.10
East St. Louis →
Office / nonfacility
Unavailable
Facility
$176.95
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$170.08
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$182.49
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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 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.
5,56245820,,Repair rectourethral fistula,A,,19.86,11.13,NA,11.13,,5.30,36.29,36.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56345825,,Repair fistula w/colostomy,A,,23.57,13.90,NA,13.90,,6.31,43.78,43.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56445900,,Reduction of rectal prolapse,A,,2.92,2.62,NA,2.62,,0.79,6.33,6.33,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56545905,,Dilation of anal sphincter,A,,2.29,2.35,NA,2.35,,0.42,5.06,5.06,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56645910,,Dilation of rectal narrowing,A,,2.78,2.37,NA,2.37,,0.48,5.63,5.63,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56745915,,Remove rectal obstruction,A,,3.11,8.35,,3.21,,0.62,12.08,6.94,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56845990,,Surg dx exam anorectal,A,,1.76,0.87,NA,0.87,,0.35,2.98,2.98,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00