CPT code 45820: Fistula repair2026 Medicare rate & RVUs in Oklahoma
Reports operative closure of an abnormal connection between the rectum and urethra, selected when that specific tract is repaired without the colostomy variant.
CMS doesn’t publish an office rate for 45820 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 45820 covers
This service repairs a tract connecting the rectum and urethra. Patients may have urine passing through the rectum, recurrent urinary infections, or fecal contamination of the urinary tract. A colorectal surgeon, urologist, or both may perform the repair, commonly in a hospital operating room. The condition may follow pelvic surgery, radiation, or injury; the operative report should identify the tract and describe its closure.
Select this code for repair of the rectourethral connection; a repair that includes colostomy is represented by a different code in this family. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be allowed; 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.
45820 in Oklahoma
| Payment locality | Office | Facility |
|---|---|---|
| Oklahoma | Unavailable | $1,132.86 |
How the 45820 rate is calculated
Each of 45820’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 · 45820
RVUs × geographic indexes × conversion factor
Work19.86
19.86 RVUs× 1.000 GPCI
Practice expense11.13
11.13 RVUs× 1.000 GPCI
Malpractice5.30
5.30 RVUs× 1.000 GPCI
Adjusted RVUs
36.2900
Conversion factor
$33.4009
Medicare rate
$1,212.12
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 45820
45820 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45820
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 · 45820
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
45820 without 51 · national facility
$1,212.12
Fistula repair
45820-51 · Second procedure: 50%
$606.06
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%).
45820 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 45825Fistula repair
- Both address a rectourethral fistula. Choose 45825 when the repair includes colostomy; use 45820 for the repair without that variant.
- 45800Fistula repair
- This code addresses a rectal-to-bladder fistula. Use 45820 when the tract connects the rectum to the urethra.
- 45805Fistula repair
- This is a fistula repair variant that includes colostomy. Distinguish it from 45820 by the tract and the procedure documented.
45820 billing questions
How is this code distinguished from 45825?
Use 45820 for repair of the rectourethral fistula without the colostomy variant. Code 45825 represents rectourethral fistula repair with colostomy.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of the descriptor or anatomy.
How are other same-session procedures paid?
Under the standard multiple procedure rule, the highest-valued procedure is paid in full and other procedures are reduced to 50% when performed in the same session.
What documentation supports reporting 45820?
The operative report should establish that the fistula connects the rectum and urethra and describe the repair. Document any colostomy procedure separately as part of selecting the appropriate code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be allowed. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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