No office rate
Choose 45130 for perineal mucosal excision and muscle plication without rectal resection. Choose 45135 when the perineal operation includes rectal resection.
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CMS RVU26D · Effective 2026-10-01
45130 Rectal prolapse repair Medicare reimbursement rates in Utah
Reports perineal repair of rectal prolapse using mucosal excision and muscle plication, commonly performed as a Delorme procedure. Compare 45130 office and facility rates across CMS payment localities in Utah.
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 45130 in Utah?
Utah 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
$976.03
1 of 1 localities have a supported rate.
Payment area: Utah
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.
Colorectal surgery
About 45130: Perineal excision for rectal prolapse
Reports perineal repair of rectal prolapse using mucosal excision and muscle plication, commonly performed as a Delorme procedure.
A colorectal or general surgeon may perform this perineal operation for rectal prolapse using a Delorme technique. The surgeon separates and removes a sleeve of prolapsed rectal mucosa, plicates the underlying rectal muscle, and closes the mucosa. The repair addresses the prolapse without the rectal and sigmoid resection associated with an Altemeier procedure. It is generally performed in an operating room under anesthesia.
Report the code when the operative note supports perineal mucosal excision and muscle plication for prolapse. Document the prolapse, operative approach, and work performed so the service can be distinguished from perineal resection or rectopexy. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 45130
- 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 RVU18.04 · 60%
- Practice expense (office) RVU8.80 · 29%
- Malpractice RVU3.24 · 11%
1.6K
Medicare services in 2024 · #2609 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.
45130 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
Code 45505 describes mucosal proctoplasty for prolapse. This code represents a Delorme-type excision and plication repair.
No office rate
Code 45540 describes abdominal rectopexy, which fixes the rectum rather than excising a mucosal sleeve through a perineal approach.
Compare 45130 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
Utah →
Office / nonfacility
Unavailable
Facility
$976.03
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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 45130 in Utah.
PPRRVU2026_Oct_nonQPP.csv
5,477
- Code
- 45130
- Physician work
- 18.04
- Practice expense
- 8.80
- Malpractice
- 3.24
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.04 | × 1.000 | 18.0400 |
| Practice expense | 8.80 | × 0.940 | 8.2720 |
| Malpractice | 3.24 | × 0.898 | 2.9095 |
| Total RVUs | 29.2215 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$976.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.04 | 1 |
| Practice expense | 8.8 | 0.94 |
| Malpractice | 3.24 | 0.898 |
(18.04 × 1 + 8.8 × 0.94 + 3.24 × 0.898) × $33.4009 = $976.03
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.
45130 billing questions
How is this code distinguished from 45135?
This code describes a perineal mucosal excision with muscle plication, as in a Delorme procedure. Code 45135 describes perineal prolapse surgery with rectal resection, as in an Altemeier procedure.
Which operative details support reporting this code?
Document rectal prolapse, the perineal approach, mucosal sleeve excision, and plication of the underlying muscle. The note should make clear whether rectal resection was performed.
Can the mucosal excision and muscle plication be reported separately?
They are integral steps of the prolapse repair represented by this code, not separate procedures to report individually.
Should modifier 50 be appended for prolapse on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How does CMS treat an assistant or co-surgeon?
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.
5,47445121,,Removal of rectum and colon,A,,28.35,12.87,NA,12.87,,7.59,48.81,48.81,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47545123,,Partial proctectomy,A,,18.39,9.25,NA,9.25,,3.28,30.92,30.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47645126,,Pelvic exenteration,A,,47.87,18.16,NA,18.16,,8.30,74.33,74.33,0,090,0.12,0.74,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47745130,,Excision of rectal prolapse,A,,18.04,8.80,NA,8.80,,3.24,30.08,30.08,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,47845135,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985