No office rate
This code is for a rectum-to-bladder fistula. Choose 45805 for a rectum-to-vagina fistula with colostomy diversion.
On this page
CMS RVU26D · Effective 2026-10-01
45805 Fistula repair Medicare reimbursement rates in Maine
Surgical closure of a rectum-to-vagina fistula performed with colostomy diversion, reported when both are part of the operative treatment. Compare 45805 office and facility rates across CMS payment localities in Maine.
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 45805 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1281.95–$1314.34
2 of 2 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.
Colorectal surgery
About 45805: Rectovaginal Fistula Repair With Colostomy
Surgical closure of a rectum-to-vagina fistula performed with colostomy diversion, reported when both are part of the operative treatment.
This operation closes an abnormal passage between the rectum and vagina while providing colostomy diversion as part of the surgical treatment. A colorectal surgeon typically performs the repair in an operating room; a gynecologic surgeon may participate when the vaginal side of the tract requires surgical work. The service is used for a documented rectovaginal fistula, not a fistula connecting the rectum to the bladder or urethra.
Choose this code when the operative report supports both rectovaginal fistula closure and colostomy in the treatment. Document the fistula’s anatomy, the repair performed, and the diversion procedure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45805
- 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 RVU22.74 · 55%
- Practice expense (office) RVU12.89 · 31%
- Malpractice RVU6.08 · 15%
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.
45805 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
This code addresses a rectum-to-urethra fistula. The tract’s destination distinguishes it from a rectovaginal repair.
No office rate
This related repair-with-colostomy code is for a different fistula anatomy. Select based on the documented organs connected by the tract.
Compare 45805 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$1281.95
Southern Maine →
Office / nonfacility
Unavailable
Facility
$1314.34
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45805 billing questions
When should 45805 be selected over another fistula repair code?
Use it for a rectum-to-vagina fistula repaired with colostomy diversion. A rectovesical or rectourethral tract has a different code.
Is the colostomy included in this service?
The code describes fistula repair with colostomy. Document the diversion in the operative report rather than treating it as an unrelated service.
Should modifier 50 be used for a fistula involving both sides?
No. The anatomy does not support bilateral reporting with modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services 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 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.
5,5584562F,,Pt w/o coronary artery stent,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
5,5594563F,,Pt recvd aspirin w/in 24 hrs,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
5,56045800,,Repair rect/bladder fistula,A,,19.80,11.12,NA,11.12,,5.29,36.21,36.21,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56145805,,Repair fistula w/colostomy,A,,22.74,12.89,NA,12.89,,6.08,41.71,41.71,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56245820,,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