Billing code 45800: Fistula repairMedicare rate & RVUs in Oklahoma
Surgical closure of a communication between the rectum and urinary bladder, reported when operative repair is performed without the colostomy service represented by its sibling code.
CMS doesn’t publish an office rate for 45800 in Oklahoma.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 45800 covers
Code 45800 represents operative repair of a fistulous tract connecting the rectum with the urinary bladder. A colorectal or urologic surgeon typically performs the procedure in a hospital operating room. Patients may present with recurrent urinary infections, pneumaturia, or fecal material in the urine; the operative findings and documented tract establish the anatomy being repaired. The repair may be part of treatment for disease or injury affecting the pelvic organs.
Select this service when the operative report documents rectum-to-bladder repair without the colostomy service represented by 45805. The record should identify the fistula site and describe the repair performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this repair. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
45800 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $1,130.30 |
How the 45800 rate is calculated
Each of 45800’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45800
RVUs × geographic indexes × conversion factor
Work19.80
19.80 RVUs× 1.000 GPCI
Practice expense11.12
11.12 RVUs× 1.000 GPCI
Malpractice5.29
5.29 RVUs× 1.000 GPCI
Adjusted RVUs
36.2100
Conversion factor
$33.4009
Medicare rate
$1,209.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45800
45800 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45800
Fistula repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 45800
Fistula repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45800 without 51 · national facility
$1,209.45
Fistula repair
45800-51 · Second procedure: 50%
$604.73
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45800 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45805Fistula repair
- Both address a rectum-to-bladder fistula. Choose 45805 when the operative service includes colostomy; 45800 represents repair without that service.
- 45820Fistula repair
- 45820 addresses a rectum-to-urethra fistula. Choose 45800 when the tract connects the rectum to the bladder.
- 45825Fistula repair
- 45825 addresses rectourethral fistula repair with colostomy. The fistula site is urethral, not bladder, as with 45800.
45800 billing questions
How does 45800 differ from 45805?
45800 represents rectum-to-bladder fistula repair without the colostomy service represented by 45805. Check the operative report for whether the repair included colostomy.
When would 45820 be more appropriate?
Use 45820 when the fistula connects the rectum with the urethra rather than the bladder. The documented anatomy, not the symptoms alone, distinguishes the codes.
Can modifier 50 be used?
No. Modifier 50 is not appropriate for this repair; the service is not a bilateral procedure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
An assistant at surgery 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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