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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the RectumCPT cpt-45120-abdominoperineal-rectal-resection-colon-anastomosis
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    CPT 45120: Abdominoperineal Resection of Rectum

    Medicare pays $1508 on average nationally for this procedure.

    CPT code 45120 describes an abdominoperineal resection in which the surgeon removes or bypasses a diseased portion of the rectum and connects the colon to the anus using both an abdominal and perineal approach; service type: surgical resection with combined abdominal and perineal operative techniques; typical site of service: inpatient hospital operating room for major colorectal surgery.

    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

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with a long history of rectal cancer who presents with a locally advanced, nonmetastatic tumor involving the distal rectum and perineal tissues. After multidisciplinary review and neoadjuvant chemoradiation, the surgical team schedules an abdominoperineal resection to remove the diseased rectum and create a permanent colostomy. The procedure uses both an abdominal and perineal approach: an exploratory laparotomy or minimally invasive abdominal mobilization of the colon, ligation of mesenteric vessels, resection of the rectum, and a perineal dissection with removal of the distal rectum and anal canal. Intraoperative steps include identification and protection of ureters, pelvic hemostasis, specimen extraction, and creation of an end colostomy.

    Typical clinical workflow:

    • Preoperative evaluation with history, physical exam, colonoscopy, pelvic MRI, CT chest/abdomen/pelvis, and anesthesia assessment.

    • Preop optimization (bowel prep as indicated, VTE prophylaxis planning, perioperative antibiotics).

    • Operation in the operating room under general anesthesia with both abdominal and perineal teams as needed.

    • Postoperative inpatient care in a surgical ward or step-down unit with pain control, stoma education, wound care, and discharge planning.

    Typical site of service: Hospital inpatient operating room and postoperative inpatient stay.

    Service type: Major surgical procedure—abdominoperineal resection (open or combined approach) requiring surgical and perioperative inpatient resources.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44140Colectomy, partial; with anastomosisPerformed if additional colonic resection with primary anastomosis is necessary during abdominal mobilization.
    44204Laparoscopy, surgical, colon resection; with colorectal anastomosisLaparoscopic approach codes that may be used if portions of the operation are minimally invasive prior to perineal completion.
    45395Colonoscopy, flexible; with removal of tumor(s) by transanal surgical approachMay be used for diagnostic or therapeutic transanal tumor management in staged or combined procedures.
    44160Colectomy, total; when subtotal colectomy portions are requiredUsed if a more extensive colectomy is performed in conjunction with rectal resection.
    49560Repair of incisional or ventral hernia with or without meshMay be reported if an abdominal wall repair is performed in the same operative session.

    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…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208100000X
    207L00000X
    207R00000X
    363L00000X
    333300000X
    207PE0005X
    363LP0200X
    282J00000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    B96.89Other specified bacterial agents as the cause of diseases classified elsewhere
    C20Malignant neoplasm of rectum
    C21.0Malignant neoplasm of anus, unspecified
    C21.1Malignant neoplasm of anal canal
    K50.911Crohn's disease, unspecified, with rectal bleeding
    K50.912Crohn's disease, unspecified, with intestinal obstruction
    K51.012Ulcerative (chronic) pancolitis with intestinal obstruction
    K51.014Ulcerative (chronic) pancolitis with abscess
    K51.413Inflammatory polyps of colon with fistula
    K52.89Other specified noninfective gastroenteritis and colitis

    Showing 1–10 of 26

    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-45112-RECTAL-RESECTION-COLON-TO-ANUS-ANASTOMOSIS

    CPT 45112: Abdominoperineal Resection of Rectum

    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-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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