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CMS RVU26D · Effective 2026-10-01

45005 Rectal abscess drainage Medicare reimbursement rates in Nebraska

Reports incision and drainage of an abscess beneath the rectal mucosa, rather than drainage of a pelvic or perirectal collection. Compare 45005 office and facility rates across CMS payment localities in Nebraska.

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 45005 in Nebraska?

Nebraska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

$334.29

1 of 1 localities have a supported rate.

Payment area: Nebraska

One mapped payment locality.

Facility setting

$156.09

1 of 1 localities have a supported rate.

Payment area: Nebraska

One mapped payment locality.

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 45005 in your payment locality →

Colorectal surgery

About 45005: Rectal submucosal abscess drainage

Reports incision and drainage of an abscess beneath the rectal mucosa, rather than drainage of a pelvic or perirectal collection.

Code 45005 describes incision and drainage of an abscess located beneath the rectal mucosa. A colorectal or general surgeon typically accesses the collection through the rectum, incises the involved area, and evacuates the abscess. The operative note should identify the submucosal rectal location and document the incision and drainage performed; a pelvic or perirectal collection is not this service.

Report this code for the submucosal rectal abscess, not solely because an abscess is near the rectum. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Report the service once for the rectal site; modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.

CMS billing rules for 45005

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 RVU1.97 · 18%
  • Practice expense (office) RVU8.50 · 77%
  • Malpractice RVU0.51 · 5%

43

Medicare services in 2024 · #5452 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.

45005 compared with similar codes

Office rates for Nebraska, from the same CMS release.

45020

Abscess drainage

Perirectal, transperineal approach

No office rate

Use 45005 for an abscess beneath the rectal mucosa. Use 45020 for a perirectal abscess drained through a transrectal approach.

45000

Pelvic abscess drainage

Transrectal approach

No office rate

45000 describes drainage of a pelvic abscess by a transrectal, transvaginal, or percutaneous approach; 45005 is specific to a submucosal abscess in the rectum.

46040

Abscess drainage

Ischiorectal or intramural

$573.38

46040 is for an ischiorectal or perirectal abscess. Choose 45005 when the documented collection is submucosal within the rectum.

46050

Perianal abscess drainage

Superficial abscess

$245.38

46050 is for a superficial perianal abscess. Code 45005 is for an abscess beneath the rectal mucosa.

Compare 45005 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.

1 of 1 payment localities

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

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45005 in Nebraska.

PPRRVU2026_Oct_nonQPP.csv

5,460

Code
45005
Physician work
1.97
Practice expense
8.50
Malpractice
0.51

GPCI2026.csv

72

Locality
Nebraska
Physician work
1.000
Practice expense
0.923
Malpractice
0.378
Office / nonfacility calculation for 45005 in Nebraska
ComponentRVULocality factorAdjusted
Physician work1.97× 1.0001.9700
Practice expense8.50× 0.9237.8455
Malpractice0.51× 0.3780.1928
Total RVUs10.0083
Conversion factor× 33.4009

Office / nonfacility rate, Nebraska$334.29

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work1.971
Practice expense8.50.923
Malpractice0.510.378

(1.97 × 1 + 8.5 × 0.923 + 0.51 × 0.378) × $33.4009 = $334.29

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work1.971
Practice expense2.720.923
Malpractice0.510.378

(1.97 × 1 + 2.72 × 0.923 + 0.51 × 0.378) × $33.4009 = $156.09

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

45005 billing questions

How does 45005 differ from 45020?

45005 is for an abscess beneath the rectal mucosa. Code 45020 describes drainage of a perirectal abscess by a transrectal approach.

What documentation supports 45005?

Document the abscess location within the rectal wall, the incision, and drainage performed. The record should distinguish a submucosal collection from a pelvic, perirectal, or superficial perianal abscess.

Are postoperative visits separately reported?

Related postoperative visits for 10 days are included in the global period.

Can modifier 50 be used?

No. Report the service once for the rectal site; the anatomy makes modifier 50 inappropriate.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are reduced to 50% under the standard multiple procedure rule.

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 45005PPRRVU2026_Oct_nonQPP.csv, line 5,460 (RVU26D)
Geographic factors for NebraskaGPCI2026.csv, line 72 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet