No office rate
45100 is for obtaining a rectal tissue sample; 45160 represents removal of a localized lesion.
On this page
CMS RVU26D · Effective 2026-10-01
45160 Rectal lesion excision Medicare reimbursement rates in Oregon
Reports surgical removal of a localized rectal lesion, such as an adenoma, when the procedure removes the lesion rather than taking a diagnostic sample. Compare 45160 office and facility rates across CMS payment localities in Oregon.
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 45160 in Oregon?
Oregon has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$932.94–$982.07
2 of 2 localities have a supported rate.
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.
Colorectal surgery
About 45160: Rectal lesion excision
Reports surgical removal of a localized rectal lesion, such as an adenoma, when the procedure removes the lesion rather than taking a diagnostic sample.
A surgeon removes a localized lesion from the rectum, rather than taking tissue only for diagnosis. A colorectal surgeon or other surgeon performing rectal operations typically performs the service in an operating room, often in a facility setting. A rectal adenoma is one example; the operative plan and documented procedure determine whether this excision code or a more specific rectal tumor procedure applies.
Report the service when the operative note supports excision of the rectal lesion. Documentation should identify the lesion and describe the removal performed, so the service can be distinguished from biopsy, tumor destruction, or removal of part or all of the rectum. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45160
- 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 RVU15.92 · 54%
- Practice expense (office) RVU9.06 · 31%
- Malpractice RVU4.25 · 15%
12
Medicare services in 2024 · #6150 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.
45160 compared with similar codes
Office rates for Oregon, from the same CMS release.
No office rate
45171 identifies transanal rectal tumor excision with a partial-thickness procedure. Select it when that specific procedure is documented.
No office rate
45172 identifies transanal rectal tumor excision with a full-thickness procedure. The operative report must support that distinction.
No office rate
45190 is for destruction of a rectal tumor; 45160 is used when the lesion is excised.
Compare 45160 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.
2 of 2 payment localities
Portland →
Office / nonfacility
Unavailable
Facility
$982.07
Rest Of Oregon →
Office / nonfacility
Unavailable
Facility
$932.94
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
45160 billing questions
How does this differ from rectal biopsy code 45100?
Code 45160 represents excision of a lesion; 45100 is for obtaining a rectal tissue sample for diagnosis. Choose based on the procedure documented, not simply the lesion’s suspected diagnosis.
When would 45171 or 45172 be a better fit?
Those codes describe transanal rectal tumor excision with partial- or full-thickness distinctions. Use them when the operative documentation supports their specific procedure and depth, rather than relying on the general lesion-excision description.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 does not apply.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. 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 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.
5,47845135,,Excision of rectal prolapse,A,,21.80,10.88,NA,10.88,,3.13,35.81,35.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47945136,,Excise ileoanal reservior,A,,30.05,14.58,NA,14.58,,4.32,48.95,48.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48045150,,Excision of rectal stricture,A,,5.70,5.31,NA,5.31,,1.51,12.52,12.52,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48145160,,Excision of rectal lesion,A,,15.92,9.06,NA,9.06,,4.25,29.23,29.23,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48245171,,Exc rect tum transanal part,A,,7.93,8.83,NA,8.83,,1.56,18.32,18.32,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48345172,,Exc rect tum transanal full,A,,11.83,9.81,NA,9.81,,2.16,23.80,23.80,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,48445190,,Destruction rectal tumor,A,,10.16,8.52,NA,8.52,,1.45,20.13,20.13,0,090,0.09,0.81,0.10,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00