No office rate
Both codes describe transanal rectal tumor excision. Choose 45172 when the excision includes full-thickness rectal wall; 45171 describes excision without that extent.
On this page
CMS RVU26D · Effective 2026-10-01
45172 Rectal tumor excision Medicare reimbursement rates in Pennsylvania
A colorectal surgeon removes a localized rectal tumor through the anus with a full-thickness segment of rectal wall, typically as definitive local treatment. Compare 45172 office and facility rates across CMS payment localities in Pennsylvania.
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 45172 in Pennsylvania?
Pennsylvania 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
$764.11–$829.41
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 45172: Full-thickness transanal rectal tumor excision
A colorectal surgeon removes a localized rectal tumor through the anus with a full-thickness segment of rectal wall, typically as definitive local treatment.
A colorectal surgeon excises a rectal tumor through the anus, removing the lesion along with the full thickness of the rectal wall at the operative site. This is a local excision rather than removal of the rectum. The service is generally performed in an operating room for a rectal lesion selected for transanal surgical treatment; the excised tissue is available for pathologic examination.
Report this code when the operative note supports a transanal approach and full-thickness removal of the rectal wall, not a superficial or partial-thickness excision. Document the lesion treated and the extent and route of excision. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. For multiple procedures 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 single-organ procedure. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery billing is not permitted.
CMS billing rules for 45172
- 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 RVU11.83 · 50%
- Practice expense (office) RVU9.81 · 41%
- Malpractice RVU2.16 · 9%
2K
Medicare services in 2024 · #2477 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.
45172 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
45160
No office rateRectal lesion excision
This code is for tumor excision through a transsacral or transcoccygeal route. 45172 uses a transanal route and includes full-thickness wall excision.
No office rate
45100 describes rectal biopsy for tissue sampling. 45172 describes removal of the tumor with full-thickness rectal wall excision.
No office rate
45190 describes destruction of a rectal tumor. 45172 is used when the tumor and full-thickness rectal wall are excised.
Compare 45172 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
Metropolitan Philadelphia →
Office / nonfacility
Unavailable
Facility
$829.41
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$764.11
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.
45172 billing questions
How does this differ from 45171?
45172 is for transanal excision that removes the full thickness of the rectal wall. Use 45171 for the transanal tumor excision that does not require full-thickness removal.
Is a transanal biopsy reported with this excision?
A biopsy code describes tissue sampling, while 45172 describes definitive full-thickness tumor excision. The operative documentation should establish whether an excision or only a diagnostic sample was performed.
Can modifier 50 be used for tumors on both sides of the rectum?
No. Modifier 50 is inappropriate for this rectal excision; report the service as a single procedure.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for the operation.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery billing is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
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.
5,48045150,,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
5,4854525F,,Neuropsychia interven order,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,4864526F,,Neuropsychia interven rcvd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00