No office rate
Choose 45397 when the laparoscopic operation creates an ileal pouch with an ileoanal connection. Choose 45395 for laparoscopic proctectomy with colostomy instead.
On this page
CMS RVU26D · Effective 2026-10-01
45397 Proctectomy Medicare reimbursement rates in Wyoming
Reports laparoscopic complete proctectomy with creation of an ileal pouch and connection to the anus, with or without a diverting ileostomy. Compare 45397 office and facility rates across CMS payment localities in Wyoming.
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 45397 in Wyoming?
Wyoming 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
$1888.43
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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 45397: Laparoscopic proctectomy with ileal pouch
Reports laparoscopic complete proctectomy with creation of an ileal pouch and connection to the anus, with or without a diverting ileostomy.
A colorectal surgeon uses a laparoscopic approach to remove the rectum and create an ileal reservoir, typically an S- or J-shaped pouch, connected to the anus. This restorative operation may be performed for conditions such as ulcerative colitis or familial adenomatous polyposis. A diverting ileostomy may also be created to protect the pouch connection; it is included in the service when performed.
Select this code when the operative report supports laparoscopic complete proctectomy, ileal pouch construction, and ileoanal anastomosis. The pouch and anastomosis distinguish it from laparoscopic proctectomy with colostomy. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted. Modifier 50 is inappropriate for this unpaired anatomy.
CMS billing rules for 45397
- 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 RVU35.59 · 61%
- Practice expense (office) RVU16.39 · 28%
- Malpractice RVU6.16 · 11%
131
Medicare services in 2024 · #4661 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.
45397 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
45113 describes the open approach to complete proctectomy with ileal pouch reconstruction; 45397 describes the laparoscopic approach.
No office rate
44212 is for laparoscopic total colectomy with proctectomy and ileal pouch reconstruction. Use 45397 when the documented procedure is proctectomy with pouch creation rather than total colectomy.
Compare 45397 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$1888.43
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 45397 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,529
- Code
- 45397
- Physician work
- 35.59
- Practice expense
- 16.39
- Malpractice
- 6.16
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 35.59 | × 1.000 | 35.5900 |
| Practice expense | 16.39 | × 1.000 | 16.3900 |
| Malpractice | 6.16 | × 0.740 | 4.5584 |
| Total RVUs | 56.5384 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$1888.43
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 35.59 | 1 |
| Practice expense | 16.39 | 1 |
| Malpractice | 6.16 | 0.74 |
(35.59 × 1 + 16.39 × 1 + 6.16 × 0.74) × $33.4009 = $1888.43
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.
45397 billing questions
How does this differ from 45395?
45397 includes creation of an ileal pouch and an ileoanal connection. 45395 describes laparoscopic proctectomy with colostomy rather than pouch reconstruction.
Is a diverting ileostomy included?
Yes. The service includes a diverting ileostomy when performed, so its presence does not change the choice of 45397.
What operative details support 45397?
Document the laparoscopic approach, complete rectal removal, ileal reservoir construction, and ileoanal anastomosis. Note whether a diverting ileostomy was created.
Can modifier 50 be used?
No. The procedure involves unpaired anatomy, so modifier 50 is inappropriate.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
What is the postoperative global period?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,52645392,,Colonoscopy w/endoscopic fnb,A,,5.36,1.99,NA,1.99,,0.61,7.96,7.96,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52745393,,Colonoscopy w/decompression,A,,4.56,1.42,NA,1.42,,0.56,6.54,6.54,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,52845395,,Lap removal of rectum,A,,32.18,15.69,NA,15.69,,6.00,53.87,53.87,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,52945397,,Lap remove rectum w/pouch,A,,35.59,16.39,NA,16.39,,6.16,58.14,58.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,53045398,,Colonoscopy w/band ligation,A,,4.10,22.32,,1.57,,0.60,27.02,6.27,0,000,0.00,0.00,0.00,3,0,1,0,0,9,45378,33.4009,09,0,99,0.00,0.00,0.00
5,53145399,,Unlisted procedure colon,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,1,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,53245400,,Laparoscopic proc,A,,18.95,8.96,NA,8.96,,3.36,31.27,31.27,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,