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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the RectumCPT cpt-45121-pull-through-resection-abdominal-perineal-colorectal-anastomosis
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    CPT 45121: Abdominoperineal Resection with Colon-to-Anus Anastomosis

    Medicare pays $1640 on average nationally for this procedure.

    CPT code 45121 describes a combined abdominal and perineal surgical resection of diseased rectum with removal of part or all of the colon or ileum and restoration of continuity by connecting the remaining colon to the anus; the service includes multiple intraoperative biopsies of the diseased colon tissue and is performed as a major abdominal and perineal operative procedure, typically provided in an inpatient hospital operating room or surgical suite.

    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 typical patient is a 58-year-old male with long-standing ulcerative colitis who presents with recurrent rectal bleeding, chronic tenesmus, weight loss, and failure of medical management including corticosteroids and biologic therapy. Preoperative evaluation includes colonoscopy with biopsy confirming dysplasia, CT abdomen/pelvis to evaluate extent of disease and rule out metastasis, and preoperative clearance with cardiology and anesthesia. The surgical team plans a total proctocolectomy with ileal pouch-anal anastomosis performed using combined abdominal and perineal approaches. Intraoperatively, the surgeon removes the diseased rectum and affected colon segments, creates an ileal pouch, and connects the remaining bowel to the anus; multiple biopsies of colonic tissue are taken for margin assessment and pathology. Typical perioperative workflow includes informed consent, bowel prep, prophylactic antibiotics, intraoperative specimen handling and pathology requests for frozen sections if indicated, postoperative monitoring in a surgical ward or ICU depending on comorbidity, and coordination of home health or ostomy care if a temporary diverting ileostomy is created. Typical site of service is an inpatient acute care hospital operating suite; ambulatory surgery centers are not appropriate for this extensive combined abdominal and perineal resection.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44140Colectomy, partial; with anastomosisMay be performed for segmental colon disease preceding or as an alternative to total proctocolectomy; related when additional colonic resection is required.
    45123Proctocolectomy, total, with ileostomy or ileal pouch-anal anastomosis; without mucosectomyClosely related variant when mucosectomy is not performed; used in similar clinical settings and may be selected depending on surgical technique.
    44120Enterectomy, resection of small intestine; single resection and anastomosisMay be performed if small bowel resection is required for ischemia or disease identified intraoperatively.
    76930Ultrasound guidance for needle placement (e.g., drain)May be used pre- or postoperatively for placement of abdominal or pelvic drains or abscess drainage under imaging guidance.
    49905Colostomy closure, takedown of colostomyPerformed later in the care continuum if a temporary ostomy was created during the proctocolectomy and later reversed.

    Related Modifiers

    14 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…
    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…

    Showing 1–10 of 14

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207V00000X
    2086S0122X
    208800000X
    146E00000X
    163WM1400X
    207UN0902X
    2865M2000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    A09Infectious gastroenteritis and colitis, unspecified
    B37.7Candidal sepsis
    C18.7Malignant neoplasm of sigmoid colon
    C18.9Malignant neoplasm of colon, unspecified
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    D12.0Benign neoplasm of cecum
    D12.6Benign neoplasm of colon, unspecified
    I78.0Hereditary hemorrhagic telangiectasia
    K51.00Ulcerative (chronic) pancolitis without complications

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

    CPT 45120: Abdominoperineal Resection of Rectum

    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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