No office rate
Choose 45541 for a perineal repair; choose 45540 for an abdominal repair.
On this page
CMS RVU26D · Effective 2026-10-01
45540 Rectal prolapse repair Medicare reimbursement rates in Pennsylvania
Reported for an abdominal operation that repairs rectal prolapse without the sigmoid resection included in a separate code. Compare 45540 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 45540 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
$945.68–$1016.82
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 45540: Abdominal rectal prolapse repair
Reported for an abdominal operation that repairs rectal prolapse without the sigmoid resection included in a separate code.
A surgeon uses an abdominal approach to restore and support a prolapsing rectum, commonly by securing it within the pelvis as a rectopexy. The operation is performed for rectal prolapse and is typically done in a hospital operating room by a colorectal or general surgeon. The abdominal approach distinguishes this service from repair through the perineum and from laparoscopic rectopexy codes.
Select this code when the operative report documents an abdominal repair without sigmoid resection; use the separate resection code when sigmoid resection is part of the operation. The report should identify the prolapse, approach, repair performed, and any resection. The day-before preoperative visit and 90 days of related postoperative care are included. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Report the repair once; modifier 50 is not appropriate. Assistant-at-surgery payment may be available, co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 45540
- 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 RVU17.67 · 61%
- Practice expense (office) RVU8.32 · 29%
- Malpractice RVU3.18 · 11%
328
Medicare services in 2024 · #3926 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.
45540 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
45550 includes sigmoid resection with the abdominal prolapse repair. 45540 describes the repair without that resection.
No office rate
45400 describes laparoscopic rectopexy without resection. 45540 describes the abdominal approach represented by its code.
No office rate
45402 describes laparoscopic rectopexy with resection; 45540 is the abdominal repair code without sigmoid resection.
Compare 45540 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
$1016.82
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$945.68
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.
45540 billing questions
How is 45540 distinguished from 45550?
45540 describes abdominal repair without sigmoid resection. When the abdominal prolapse repair includes sigmoid resection, use 45550.
When should 45541 be reported instead?
45541 describes repair through a perineal approach. Use 45540 when the surgeon repairs the prolapse through an abdominal approach.
Does 45540 describe laparoscopic rectopexy?
No. Laparoscopic rectopexy is described by 45400 without resection or 45402 with resection; 45540 is for the abdominal approach represented by that code.
What operative documentation supports 45540?
Document the rectal prolapse, the abdominal approach, and the repair performed. State whether sigmoid resection was performed so the applicable repair code can be selected.
How does the global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the surgical global period.
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.
5,54145520,,Treatment of rectal prolapse,A,,0.54,4.44,,0.52,,0.07,5.05,1.13,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5424552F,,Pt ref for speech lang path,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
5,5434553F,,Pt asst re end life issues,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
5,54445540,,Correct rectal prolapse,A,,17.67,8.32,NA,8.32,,3.18,29.17,29.17,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,54545541,,Correct rectal prolapse,A,,14.48,9.26,NA,9.26,,2.93,26.67,26.67,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,5464554F,,Pt recvd inhal anesthetic,M,,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
5,54745550,,Repair rectum/remove sigmoid,A,,24.18,11.73,NA,11.73,,4.58,40.49,40.49,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00