CPT 45126 Pelvic Exenteration Reimbursement | OpenPayer

Summary & Overview

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

CPT code 45126 designates a pelvic exenteration performed for very advanced or recurrent colorectal and genitourinary cancers. This is a major, often multi-organ surgical oncology procedure in which the urinary bladder, urethra, rectum, and anus are removed; additional reproductive organs may be resected depending on patient sex and disease extent. A colostomy may be constructed as part of the operation. Nationally, this code denotes high-complexity inpatient surgical care with substantial clinical and resource implications, including prolonged hospitalization, complex perioperative management, and multidisciplinary surgical teams.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context about the clinical indications for the procedure, the typical inpatient hospital setting, and the service classification as a major surgical oncology intervention. The publication also provides benchmarking and policy-relevant framing related to utilization and coding considerations for high-acuity surgical oncology services, as well as references to commonly applied modifiers and payer coverage patterns where applicable. Data not available in the input: associated taxonomies, ICD-10 diagnoses, related codes, and service-line details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45126pelvic exenterationsurgical oncologycolorectal cancergenitourinary cancerinpatient surgerycolostomymajor abdominal surgery

Billing Code Overview

CPT code 45126 describes an extensive pelvic exenteration procedure performed for advanced or recurrent colorectal and genitourinary malignancies. The surgeon removes pelvic organs including the urinary bladder, urethra, rectum, and anus; additional organ removal may include the uterus and one or both ovaries and/or fallopian tubes in females or the prostate in males. A colostomy may be created as part of the operation.

Service type: Major surgical oncology procedure (pelvic exenteration)
Typical site of service: Inpatient hospital surgical setting

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with long-standing locally advanced rectal adenocarcinoma presents after neoadjuvant chemoradiation with persistent tumor involving the distal rectum, anal canal, and involvement of the posterior bladder and prostate. Multidisciplinary review determines the tumor is unresectable with sphincter-sparing techniques and that an exenterative procedure is indicated to achieve oncologic control. The patient is taken to the operating room for pelvic exenteration with en bloc removal of the rectum, anus, urinary bladder, and involved reproductive organs; a permanent end colostomy and urinary diversion are created.

The clinical workflow includes preoperative staging with pelvic MRI and CT chest/abdomen/pelvis, bowel and urinary counseling, informed consent addressing stoma creation and potential sexual/urinary morbidity, perioperative antibiotics and VTE prophylaxis, coordination with urology/gynecologic oncology as needed for organ removal, intraoperative specimen orientation and margin assessment, and postoperative intensive monitoring with early involvement of wound/ostomy care and oncology for adjuvant planning.

Coding Specifications

Modifier	Description	When to Use
`00`	Default, no modifier required by payer	Rarely reported; used when a payer requires a two-character code for submission and no other modifier applies

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

CPT-45150-RECTAL-STRICTURE-INCISION

CPT 45150: Incision of Rectal Stricture

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

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45120: Abdominoperineal Rectal Resection with Colon-Anus Anastomosis

CPT-45136-ILEOANAL-RESERVOIR-REMOVAL-ILEOSTOMY-CREATION

CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy

CPT-45135-RECTAL-PROCIDENTIA-EXCISION-ABDOMINAL-PERINEAL-ANASTOMOSIS

CPT 45135: Excision of Rectal Procidentia with Abdominal and Perineal Anastomosis

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

CPT 45114: Rectal Resection and Colon-Rectal Anastomosis, Abdominal and Sacral Approach

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

CPT 45111: Partial Rectal Resection, Abdominal Approach

CPT-45160-TRANSSACRAL-TRANSCOCCYGEAL-EXCISION-RECTAL-TUMOR

CPT 45160: Excision of Rectal Tumor via Transsacral or Transcoccygeal Approach

CPT-45171-TRANSANAL-LOCAL-EXCISION-RECTAL-TUMOR

CPT 45171: Transanal Local Excision of Rectal Tumor

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Taxonomy Code	Specialty	Notes
207L00000X	Colon & Rectal Surgery	Primary specialty for complex pelvic resections for colorectal malignancy
208000000X	General Surgery	Common performing specialty for pelvic exenteration in multidisciplinary settings
2086S0123X	Surgical Oncology	Specialized oncologic surgeons performing extensive resections
2084P0800X	Urology	Involved when urinary bladder, urethra, prostate or urinary diversion is required
207V00000X	Gynecologic Oncology	Involved when female reproductive organs (uterus, ovaries, tubes) are removed

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C20`	Malignant neoplasm of rectum	Primary indication when tumor involves the rectum and requires radical resection
`C18.7`	Malignant neoplasm of sigmoid colon	Tumors of distal colon that extend into the pelvis may necessitate exenteration
`C67.9`	Malignant neoplasm of bladder, unspecified	Bladder invasion by pelvic tumors can require cystectomy as part of exenteration
`C61`	Malignant neoplasm of prostate	Locally advanced prostate cancer with pelvic organ invasion may be an indication in male patients
`C53.9`	Malignant neoplasm of cervix uteri, unspecified	Gynecologic malignancies with extensive pelvic spread can require exenterative surgery
`C54.9`	Malignant neoplasm of corpus uteri, unspecified	Uterine cancers with pelvic organ involvement may be treated with exenteration
`C76.2`	Malignant neoplasm of pelvis, unspecified	Used when primary site is pelvic with extensive local invasion requiring multiorgan resection
`Z90.2`	Acquired absence of urinary bladder	Postoperative status code used in follow-up when bladder has been removed

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44120`	Excision, large intestine; partial colectomy, with anastomosis	May be performed prior to or instead of total pelvic exenteration in less extensive disease or as part of staged resections
`51100`	Cystectomy, complete; simple	Partial component when bladder removal is performed—cystectomy coding is relevant for urinary bladder removal and diversion planning
`44625`	Proctectomy, abdominoperineal, with colostomy	Related pelvic colorectal resection that may be part of or an alternative to exenteration for distal rectal tumors
`49560`	Formation of colostomy or enterostomy	Creation of end colostomy is commonly performed during pelvic exenteration
`50820`	Repair of urinary bladder, major; transabdominal	Used when bladder reconstruction or repair is performed in conjunction with exenteration
`43415`	Cystectomy with urinary diversion (ileal conduit) [note: illustrative; actual code depends on diversion type]	Urinary diversion procedures (ileal conduit, continent reservoir) are performed concurrently and have separate CPT codes depending on technique

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