No office rate
This code concerns dilation of the anal sphincter; 45900 concerns reduction of rectal prolapse under anesthesia.
On this page
CMS RVU26D · Effective 2026-10-01
45900 Prolapse reduction Medicare reimbursement rates in Tennessee
Reports reduction of a rectal prolapse performed under anesthesia, typically when the prolapsed tissue requires reduction in an operative or procedural setting. Compare 45900 office and facility rates across CMS payment localities in Tennessee.
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 45900 in Tennessee?
Tennessee has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$191.25
1 of 1 localities have a supported rate.
Payment area: Tennessee
One mapped payment locality.
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.
Anorectal procedure
About 45900: Anorectal prolapse reduction under anesthesia
Reports reduction of a rectal prolapse performed under anesthesia, typically when the prolapsed tissue requires reduction in an operative or procedural setting.
This service covers reducing prolapsed rectal tissue while the patient is under anesthesia. A surgeon or other qualified physician may perform it in an operating room or procedural setting when the prolapse needs reduction under anesthesia. It describes reduction, not definitive surgical repair of the prolapse.
Report the service when documentation supports both the rectal prolapse and its reduction under anesthesia. The procedure has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures occur in the same session, CMS pays the highest-valued procedure in full and reduces payment for the others by the standard multiple-procedure rule. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 45900
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.92 · 46%
- Practice expense (office) RVU2.62 · 41%
- Malpractice RVU0.79 · 12%
87
Medicare services in 2024 · #4984 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.
45900 compared with similar codes
Office rates for Tennessee, from the same CMS release.
Compare 45900 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.
1 of 1 payment localities
Tennessee →
Office / nonfacility
Unavailable
Facility
$191.25
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 45900 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,564
- Code
- 45900
- Physician work
- 2.92
- Practice expense
- 2.62
- Malpractice
- 0.79
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.92 | × 1.000 | 2.9200 |
| Practice expense | 2.62 | × 0.909 | 2.3816 |
| Malpractice | 0.79 | × 0.537 | 0.4242 |
| Total RVUs | 5.7258 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$191.25
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.92 | 1 |
| Practice expense | 2.62 | 0.909 |
| Malpractice | 0.79 | 0.537 |
(2.92 × 1 + 2.62 × 0.909 + 0.79 × 0.537) × $33.4009 = $191.25
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
45900 billing questions
Does this code describe definitive repair of rectal prolapse?
No. It describes reduction under anesthesia. A definitive operation such as abdominal rectopexy or perineal proctectomy is a different service.
What documentation supports reporting the service?
Document the rectal prolapse, that the patient was under anesthesia, and the reduction performed. The record should distinguish reduction from definitive repair.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when the record supports medical necessity. CMS does not permit co-surgeon or team-surgery payment for this service.
Are postoperative visits separately included?
Related postoperative visits during the 10-day global period are included in the procedure's payment.
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.
5,56145805,,Repair fistula w/colostomy,A,,22.74,12.89,NA,12.89,,6.08,41.71,41.71,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56245820,,Repair rectourethral fistula,A,,19.86,11.13,NA,11.13,,5.30,36.29,36.29,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56345825,,Repair fistula w/colostomy,A,,23.57,13.90,NA,13.90,,6.31,43.78,43.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56445900,,Reduction of rectal prolapse,A,,2.92,2.62,NA,2.62,,0.79,6.33,6.33,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56545905,,Dilation of anal sphincter,A,,2.29,2.35,NA,2.35,,0.42,5.06,5.06,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56645910,,Dilation of rectal narrowing,A,,2.78,2.37,NA,2.37,,0.48,5.63,5.63,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56745915,,Remove rectal obstruction,A,,3.11,8.35,,3.21,,0.62,12.08,6.94,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780