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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the RectumCPT cpt-45112-rectal-resection-colon-to-anus-anastomosis
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    CPT 45112: Abdominoperineal Resection of Rectum

    Medicare pays $1666 on average nationally for this procedure.

    CPT code 45112 describes an abdominoperineal resection in which the provider removes the rectum and performs a colorectal anastomosis by combined abdominal and perineal approaches; this surgical oncology procedure is performed to treat rectal cancer and restores an uninterrupted digestive tract so the patient can pass stool normally, typically delivered as an inpatient major abdominal surgical service in an operating room with preoperative and postoperative surgical care.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

    Progress1 / 7

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with a biopsy-proven mid-rectal adenocarcinoma presents after staging that shows a resectable tumor without distant metastases. The multidisciplinary team recommends an abdominoperineal resection with coloanal anastomosis (procedure 45112) to achieve oncologic resection while preserving bowel continuity. Preoperative workup includes colonoscopy, pelvic MRI, CT chest/abdomen/pelvis, cardiopulmonary clearance, and discussion of bowel preparation and perioperative antibiotics. The operative workflow begins with an abdominal phase to mobilize the left colon and ligate vascular pedicles, followed by a perineal phase to excise the rectum and perform a hand-sewn or stapled coloanal anastomosis. Intraoperative documentation includes indication (rectal cancer), tumor location and extent, margins, estimated blood loss, drains placed, specimen description, intraoperative complications, and disposition. Typical post-operative care includes monitoring in a surgical ward or intensive care setting as appropriate, pain control, DVT prophylaxis, early ambulation, assessment of anastomotic integrity, and coordination for adjuvant oncology if indicated. Typical site of service is an inpatient acute care hospital. Service type is a major surgical procedure (open/invasive abdominal and perineal resection) performed by colorectal or general surgeons with colorectal specialization.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44145Colectomy, partial; total abdominal colectomy with ileorectal anastomosisMay be performed when extended colonic resection is required or for synchronous disease during the same hospitalization.
    44204Laparoscopy, surgical; colectomy, partial, with anastomosisMinimally invasive alternative for colon mobilization in selected cases prior to perineal phase or as combined approach.
    45378Colonoscopy, flexible; diagnostic, with or without collection of specimenPreoperative diagnostic and surveillance colonoscopy to localize tumor and obtain biopsies.
    38531Biopsy or excision of lymph nodes (e.g., intra-abdominal)Lymph node sampling may accompany oncologic resection for staging.
    49020Exploration, peritoneal cavity, for tumor resection (laparotomy)Related to abdominal exploration and tumor debulking that can be part of the operative plan.
    99152Moderate sedation services provided by the same physician or other qualified health care professionalMay be reported for procedures requiring monitored sedation when billing rules permit (use depends on payer policy).

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207N00000X
    208000000X
    207K00000X
    2084P0800X
    106E00000X
    2080P0207X
    2080P0201X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    C21.0Malignant neoplasm of anus, unspecified
    C21.1Malignant neoplasm of anal canal
    C21.8Malignant neoplasm of overlapping sites of rectum, anus and anal canal
    D01.0Carcinoma in situ of colon
    D01.3Carcinoma in situ of anus and anal canal
    D12.6Benign neoplasm of colon, unspecified
    D37.4Neoplasm of uncertain behavior of colon
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45100-ANORECTAL-WALL-BIOPSY-ANAL-APPROACH

    CPT 45100: Anal Approach Anorectal Wall Biopsy

    CPT-45108-ANORECTAL-TUMOR-EXCISION

    CPT 45108: Excision of Tumor of Anorectal Muscle

    CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

    CPT 45110: Abdominoperineal Resection with Colostomy

    CPT-45111-PARTIAL-RECTAL-RESECTION-ABDOMINAL-APPROACH

    CPT 45111: Partial Resection of Rectum, Abdominal Approach

    CPT-45113-PROCTECTOMY-ILEOANAL-ANASTOMOSIS-ILEAL-POUCH

    CPT 45113: Partial Proctectomy with Ileoanal Anastomosis and Ileal Pouch

    CPT-45114-RECTAL-RESECTION-ANASTOMOSIS-ABDOMINAL-SACRAL-APPROACH

    CPT 45114: Abdominoperineal Resection with Colorectal Anastomosis

    CPT-45116-POSTERIOR-APPROACH-RECTAL-RESECTION-ANASTOMOSIS

    CPT 45116: Posterior Low Rectal Resection with Colon-Rectum Anastomosis

    CPT-45119-RESTORATIVE-PROCTOCOLECTOMY-WITH-COLONIC-POUCH

    CPT 45119: Abdominoperineal Proctocolectomy with Colonic Pouch

    CPT-45120-ABDOMINOPERINEAL-RECTAL-RESECTION-COLON-ANASTOMOSIS

    CPT 45120: Abdominoperineal Resection of Rectum

    CPT-45121-PULL-THROUGH-RESECTION-ABDOMINAL-PERINEAL-COLORECTAL-ANASTOMOSIS

    CPT 45121: Abdominoperineal Resection with Colon-to-Anus Anastomosis

    Showing 1–10 of 19

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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