CPT 45130 Perineal Repair Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

CPT code 45130 covers perineal surgical excision of rectal procidentia with reanastomosis of the colon to the remaining rectum. This operative approach is used to treat partial or complete rectal prolapse and is an important option in colorectal surgical care, particularly for patients where an abdominal approach is contraindicated or less desirable. National attention to this code reflects its role in managing a disabling condition that affects bowel function and quality of life.

Key payers included in the coverage and analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and common billing considerations. The publication provides benchmarks on utilization and reimbursement patterns, highlights relevant coding practice issues, and summarizes any notable policy or coverage trends affecting this procedure. The goal is to inform billing, clinical, and policy stakeholders about the clinical intent of CPT code 45130, payment landscape considerations, and operational issues relevant to surgical teams and revenue cycle staff.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 45130rectal prolapseperineal repaircolorectal surgerysurgical procedureoperating roomambulatory surgical centerreanastomosis

Billing Code Overview

CPT code 45130 describes a surgical procedure to excise a rectal procidentia (partial or complete rectal prolapse) via a perineal approach. The surgeon removes the prolapsed portion of the rectum and reconnects the colon to the remaining rectum.

Service type: Perineal surgical repair of rectal prolapse
Typical site of service: Operating room or ambulatory surgical center with a perineal approach

Clinical & Coding Specifications

Clinical Context

A typical patient is an elderly adult presenting with rectal prolapse characterized by protrusion of rectal tissue through the anal canal, fecal incontinence, mucous discharge, and obstructed defecation. After clinical evaluation by a colorectal surgeon, the patient undergoes preoperative assessment including bowel prep, anesthesia evaluation, and informed consent. On the day of service, the procedure is performed in an operating room or ambulatory surgery center under general, regional, or monitored sedation. The surgeon performs a perineal excision of the prolapsed rectum (perineal rectosigmoidectomy), resects the redundant rectum and distal sigmoid colon, and performs a colo-rectal anastomosis through a perineal approach. Postoperatively the patient is monitored in PACU and may be admitted for pain control, bowel function monitoring, and wound care. Typical workflow elements include preop diagnosis confirmation, marking of procedure, intraoperative documentation of resection length and anastomosis, and detailed operative and pathology reports to support coding and reimbursement.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or operative complexity substantially exceeds typical for the procedure due to factors such as significant bleeding, dense adhesions, or difficult dissection.

CPT 45110: Abdominoperineal Resection with Colostomy

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

CPT 45121: Pull-Through Resection with Colorectal Anastomosis

CPT-45150-RECTAL-STRICTURE-INCISION

CPT 45150: Incision of Rectal Stricture

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

CPT 45116: Posterior Rectal Resection with Colorectal Anastomosis

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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

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

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

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

CPT-45126-PELVIC-EXENTERATION-FOR-ADVANCED-COLORECTAL-GENITOURINARY-CANCER

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

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

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

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

CPT 45100: Anal Approach Biopsy of Anorectal Wall

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Taxonomy Code	Specialty	Notes
`207P00000X`	Colorectal Surgery	Primary specialty performing perineal rectosigmoidectomy/proctectomy.
`207R00000X`	General Surgery	General surgeons with colorectal focus commonly perform this procedure.
`2080P0207X`	Thoracic and Cardiovascular Surgery	Not typical; included only if multidisciplinary intraoperative involvement is present.
`207L00000X`	Colon & Rectal Surgery (alternate entry)	Alternate taxonomy for colorectal specialists in outpatient and hospital settings.
`208000000X`	Surgery	Broad surgical taxonomy for centers where general surgeons perform the procedure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.3`	Rectal prolapse	Primary indication for perineal rectosigmoidectomy; describes full- or partial-thickness rectal prolapse prompting surgical repair.
`K59.2`	Neurogenic bowel, unspecified	May coexist as a contributor to chronic constipation and prolapse in patients with neurologic disorders.
`R15.9`	Full incontinence of feces, unspecified	Common symptom leading to surgical intervention for rectal prolapse to restore continence.
`K59.0`	Constipation, unspecified	Chronic constipation and straining are risk factors and frequently present in patients with rectal prolapse.
`N39.3`	Stress urinary incontinence (female)	Pelvic floor dysfunction commonly coexists; relevant for perioperative assessment though not a direct indication.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45380`	Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	May be performed preoperatively for diagnostic evaluation or intraoperatively for inspection of distal bowel.
`44140`	Colectomy, partial; with anastomosis	Open partial colectomy codes may be used if an abdominal approach or extended resection is performed instead of the perineal approach.
`44625`	Proctopexy, for rectal prolapse (abdominal approach)	Alternative abdominal repair for rectal prolapse; relates as a different surgical approach.
`99223`	Initial hospital care, typically 70 minutes or more	Used for higher-complexity inpatient initial visit associated with preoperative or immediate postoperative management.
`59320`	Unlisted code for anorectal procedures (if needed)	Used only when a specific perineal procedure detail is not adequately described by available codes (rare).

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