Billing code 45005: Rectal abscess drainageMedicare rate & RVUs in Washington
Reports incision and drainage of an abscess beneath the rectal mucosa, rather than drainage of a pelvic or perirectal collection.
Medicare pays $378.57–$431.36 for 45005 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
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 45005 covers
Code 45005 describes incision and drainage of an abscess located beneath the rectal mucosa. A colorectal or general surgeon typically accesses the collection through the rectum, incises the involved area, and evacuates the abscess. The operative note should identify the submucosal rectal location and document the incision and drainage performed; a pelvic or perirectal collection is not this service.
Report this code for the submucosal rectal abscess, not solely because an abscess is near the rectum. Related postoperative visits during the 10-day global period are included. When multiple procedures occur in the same session, Medicare pays the highest-valued procedure in full and reduces the others to 50%. Report the service once for the rectal site; modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are 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 45005 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $378.57 | $175.28 |
| Seattle (King Cnty) | $431.36 | $194.48 |
How the 45005 rate is calculated
Each of 45005’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 · 45005
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.97Practice expense 8.50Malpractice 0.51
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45005
45005 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45005
Rectal abscess drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 45005
Rectal abscess drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45005 without 51 · national office
$366.74
Rectal abscess drainage
45005-51 · Second procedure: 50%
$183.37
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%).
45005 compared with similar codes
Compare codes
45005 vs 45020 vs 45000 vs 46040 vs 46050: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45020Abscess drainage
- Use 45005 for an abscess beneath the rectal mucosa. Use 45020 for a perirectal abscess drained through a transrectal approach.
- 45000Pelvic abscess drainage
- 45000 describes drainage of a pelvic abscess by a transrectal, transvaginal, or percutaneous approach; 45005 is specific to a submucosal abscess in the rectum.
- 46040Abscess drainage
- 46040 is for an ischiorectal or perirectal abscess. Choose 45005 when the documented collection is submucosal within the rectum.
- 46050Perianal abscess drainage
- 46050 is for a superficial perianal abscess. Code 45005 is for an abscess beneath the rectal mucosa.
45005 billing questions
How does 45005 differ from 45020?
45005 is for an abscess beneath the rectal mucosa. Code 45020 describes drainage of a perirectal abscess by a transrectal approach.
What documentation supports 45005?
Document the abscess location within the rectal wall, the incision, and drainage performed. The record should distinguish a submucosal collection from a pelvic, perirectal, or superficial perianal abscess.
Are postoperative visits separately reported?
Related postoperative visits for 10 days are included in the global period.
Can modifier 50 be used?
No. Report the service once for the rectal site; the anatomy makes modifier 50 inappropriate.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are reduced to 50% under the standard multiple procedure rule.
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
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