Billing code 45108: Anorectal myomectomyMedicare rate & RVUs in Washington
Surgical removal of a segment of anorectal muscle, reported for selected outlet-obstruction conditions such as Hirschsprung disease.
CMS doesn’t publish an office rate for 45108 in Washington.
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 8 sections
What 45108 covers
Anorectal myomectomy removes a portion of muscle in the anorectal wall. A colorectal or pediatric surgeon may perform it for selected patients with impaired outlet relaxation, including patients with Hirschsprung disease. This is a specialized muscle procedure, not a diagnostic rectal biopsy or removal of a rectal tumor, and it is generally performed in an operating room.
Report the procedure when the operative documentation supports removal of anorectal muscle for the patient’s condition; the report should identify the site, extent, and indication. Medicare treats it as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment is barred by statutory restriction; 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 45108 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $372.87 |
| Seattle (King Cnty) | Unavailable | $409.66 |
How the 45108 rate is calculated
Each of 45108’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 · 45108
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.99Practice expense 4.84Malpractice 1.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45108
45108 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 45108
Anorectal myomectomy
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 45108
Anorectal myomectomy
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
45108 without 51 · national facility
$372.75
Anorectal myomectomy
45108-51 · Second procedure: 50%
$186.38
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%).
45108 compared with similar codes
Compare codes
45108 vs 45100 vs 45160 vs 45171 vs 45172: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45100Rectal biopsy
- This code is for diagnostic rectal tissue sampling. Anorectal myomectomy removes muscle as a therapeutic procedure.
- 45160Rectal lesion excision
- This code describes excision of a rectal lesion. Use anorectal myomectomy when the operation removes anorectal muscle rather than a lesion.
- 45171Rectal tumor excision
- This code describes partial-thickness transanal excision of a rectal tumor; it is not a muscle myomectomy.
- 45172Rectal tumor excision
- This code describes full-thickness transanal excision of a rectal tumor. Anorectal myomectomy is selected for removal of anorectal muscle, not tumor excision.
45108 billing questions
How is this different from a rectal biopsy?
A biopsy obtains tissue for diagnosis. Anorectal myomectomy removes a portion of anorectal muscle as a therapeutic operation.
Can a rectal tumor excision be reported instead?
No. Tumor excision codes describe removal of a rectal lesion; this code describes removal of anorectal muscle for a different clinical purpose.
Does the procedure have a 90-day global period?
Yes. The day-before preoperative visit and related postoperative care for 90 days are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures subject to the standard multiple-procedure rule are paid at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is barred by statutory restriction. 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 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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