Billing code 45825: Fistula repairMedicare rate & RVUs in Texas
Surgical closure of a communication between the rectum and urethra performed with a colostomy to divert stool and protect the repair.
CMS doesn’t publish an office rate for 45825 in Texas.
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 45825 covers
This operation closes an abnormal passage between the rectum and urethra and creates a colostomy for fecal diversion. Colorectal or urologic surgeons may perform it for a fistula arising after pelvic surgery, radiation, trauma, or another disease process. The repair is typically undertaken in a hospital operating room, where the team can address the pelvic fistula and diversion during the same operative episode.
Report this code when the rectourethral fistula is surgically repaired with a colostomy; the operative report should identify the fistula site, repair performed, and diversion created. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 45825 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,466.77 |
| Beaumont | Unavailable | $1,405.54 |
| Brazoria | Unavailable | $1,418.04 |
| Dallas | Unavailable | $1,437.59 |
| Fort Worth | Unavailable | $1,435.69 |
| Galveston | Unavailable | $1,429.09 |
| Houston | Unavailable | $1,544.59 |
| Rest Of Texas | Unavailable | $1,418.17 |
How the 45825 rate is calculated
Each of 45825’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 · 45825
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 23.57Practice expense 13.90Malpractice 6.31
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45825
45825 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45825
Fistula repair
| 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 · 45825
Fistula repair
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
45825 without 51 · national facility
$1,462.29
Fistula repair
45825-51 · Second procedure: 50%
$731.15
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%).
45825 compared with similar codes
Compare codes
45825 vs 45820 vs 45800 vs 45805: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45820Fistula repair
- Choose 45825 when rectourethral fistula repair is performed with a colostomy; 45820 represents the related repair without that colostomy circumstance.
- 45800Fistula repair
- 45800 concerns a fistula between the rectum and bladder. This code is for a rectourethral fistula repaired with a colostomy.
- 45805Fistula repair
- Both involve fistula repair with colostomy, but 45805 is associated with a different fistula site; identify the involved organs in the operative report.
45825 billing questions
How does this differ from 45820?
Both concern rectourethral fistula repair, but 45825 is the selection when the repair is performed with a colostomy. Use 45820 when the applicable repair is performed without that colostomy.
Is the colostomy part of the service?
The code identifies rectourethral fistula repair performed with a colostomy. Document the diversion and its relationship to the repair; do not infer separate reporting from the presence of a colostomy alone.
Does modifier 50 apply?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant surgeon be paid?
CMS permits assistant-at-surgery payment for this code. Co-surgeon payment requires supporting documentation, while team surgery is not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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 reduced to 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 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 45825 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 →