Billing code 45121: ProctocolectomyMedicare rate & RVUs in Oregon
Reports complete removal of the colon and rectum with ileostomy reconstruction, such as for extensive colorectal disease requiring permanent diversion.
CMS doesn’t publish an office rate for 45121 in Oregon.
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 45121 covers
This code represents a complete resection of the colon and rectum with creation of an ileostomy. Colorectal surgeons typically perform it in an operating room for conditions requiring removal of both organs, including severe ulcerative colitis or familial adenomatous polyposis. The operative report should establish the extent of resection and the ileostomy reconstruction; a rectal-only operation or a procedure creating an ileoanal reservoir is a different service.
Report the code when the documented operation matches the complete colorectal resection and ileostomy service, rather than coding the colon and rectum removals separately. 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 additional procedures are subject to the standard 50% multiple-procedure reduction. A bilateral adjustment is not appropriate for this single colorectal resection. Assistant-at-surgery payment may be available; 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.
Where 45121 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,628.26 |
| Rest Of Oregon | Unavailable | $1,553.29 |
How the 45121 rate is calculated
Each of 45121’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 · 45121
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 28.35Practice expense 12.87Malpractice 7.59
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45121
45121 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45121
Proctocolectomy
| 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 · 45121
Proctocolectomy
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
45121 without 51 · national facility
$1,630.30
Proctocolectomy
45121-51 · Second procedure: 50%
$815.15
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%).
45121 compared with similar codes
Compare codes
45121 vs 45120 vs 45119 vs 45110 vs 45111: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45120Rectal resection
- 45120 covers rectal resection without the combined colon removal represented by 45121. Select based on the documented organs removed.
- 45119Proctectomy
- 45119 describes reconstruction with an ileoanal reservoir; 45121 is for the complete colon-and-rectum resection with ileostomy.
- 45110Rectal resection
- 45110 is a complete abdominoperineal rectal resection with colostomy. It does not describe the combined colon and rectum removal with ileostomy in 45121.
- 45111Partial proctectomy
- 45111 is a partial rectal resection with anastomosis. It is not the complete removal of both colon and rectum represented by 45121.
45121 billing questions
How does this differ from 45120?
45121 includes removal of the colon as well as the rectum, with an ileostomy. 45120 describes a rectal resection and does not represent the same complete colorectal removal.
Is the colon removal separately coded?
The combined service is represented by 45121 when the operative report supports the complete resection and ileostomy. Do not separately code the same colon removal as an additional procedure.
How does 45119 differ?
45119 describes a complete resection with an ileoanal reservoir reconstruction. Use 45121 when the documented reconstruction is an ileostomy rather than that reservoir.
What documentation supports 45121?
The operative report should identify removal of both the colon and rectum and document creation of the ileostomy. A rectal-only resection or a partial resection does not support this code.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, while 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
Fee sheets
Put 45121 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →