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CMS RVU26D · Effective 2026-10-01

45116 Partial proctectomy Medicare reimbursement rates in Missouri

Reports partial rectal removal through a transsacral approach with anastomosis when the surgeon documents this specific operative route and reconstruction. Compare 45116 office and facility rates across CMS payment localities in Missouri.

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 45116 in Missouri?

Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.

Office / nonfacility

No supported rate

Facility setting

$1351.84–$1389.15

3 of 3 localities have a supported rate.

Lowest: Rest Of Missouri

Highest: Metropolitan St. Louis

A spread of $37.31 per service.

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.

Find 45116 in your payment locality →

Where 45116 pays more and less in Missouri

Colorectal surgery

About 45116: Transsacral partial proctectomy with anastomosis

Reports partial rectal removal through a transsacral approach with anastomosis when the surgeon documents this specific operative route and reconstruction.

This service removes part of the rectum through a posterior route that accesses the rectum via the sacral or coccygeal area, then reconnects the remaining bowel. A colorectal or general surgeon may perform it for selected rectal conditions when this approach is chosen; the operative report should establish the extent of rectal resection and the route used. It is distinct from partial proctectomy performed through an abdominal, perineal, or transanal approach.

Select the code from the documented procedure and approach, not from the diagnosis alone. The operative report should describe the resection, transsacral access, and anastomosis. CMS assigns major-surgery status with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other 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. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation. Team surgery is not permitted for this code.

CMS billing rules for 45116

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 RVU27.03 · 64%
  • Practice expense (office) RVU11.20 · 27%
  • Malpractice RVU3.89 · 9%

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.

45116 compared with similar codes

Office rates for Missouri, from the same CMS release.

45111

Partial proctectomy

Abdominal approach, anastomosis

No office rate

Choose 45116 for the transsacral route. Code 45111 represents partial proctectomy through a different approach.

45112

Rectal removal

With pelvic lymphadenectomy

No office rate

Choose 45116 when the operative report documents transsacral access; 45112 is the perineal-approach sibling.

45113

Partial proctectomy

With colostomy

No office rate

Choose 45116 for a transsacral operation, not a transanal approach as represented by 45113.

45110

Rectal resection

Abdominal and perineal approach

No office rate

45116 represents partial rectal removal with anastomosis. Code 45110 is for complete rectal removal.

Compare 45116 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.

3 of 3 payment localities

Office and facility base rates · shared scale starting at $0

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45116 billing questions

Is the anastomosis reported separately?

The anastomosis is part of the partial proctectomy service represented here; the code selection should reflect the documented resection and reconstruction.

What documentation supports this code?

The operative report should identify the partial rectal resection, the transsacral route, and the anastomosis. The diagnosis alone does not establish the approach.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted for this code.

How are other same-session procedures handled?

CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to other procedures performed in the same session.

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.

RVUs for 45116PPRRVU2026_Oct_nonQPP.csv, line 5,471 (RVU26D)