CPT 45150 Rectal Stricture Incision Reimbursement | OpenPayer

Summary & Overview

CPT 45150: Incision of Rectal Stricture

CPT code 45150 denotes a surgical incision or division of a rectal stricture, a targeted colorectal operation used to relieve narrowing of the rectum due to malignancy, scarring, or other obstructive causes. Nationally, this code captures a focused set of colorectal surgical interventions that affect hospital and ambulatory surgical center utilization, perioperative planning, and reimbursement for surgeons and facilities.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and settings for the procedure, payer coverage considerations, commonly reported modifiers, and how 45150 maps to colorectal surgical service lines. The publication summarizes benchmark metrics where available, highlights recent policy shifts impacting surgical authorization and bundling, and explains how the code is used in clinical documentation and billing workflows.

This report is intended for clinicians, coding and billing professionals, and policy analysts seeking a concise reference on clinical context, typical sites of service, and payer considerations tied to CPT code 45150.

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Billing Code Overview

CPT code 45150 describes a surgical procedure to divide (incise) a stricture of the rectum, the terminal portion of the large intestine that connects to the anus. The procedure is performed to relieve narrowing caused by tumor, scar formation, or other obstructive processes.

Service type: Surgical, anorectal/colorectal procedure
Typical site of service: Hospital operating room or ambulatory surgical center

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with progressive anorectal obstructive symptoms such as difficulty passing stool, narrow-caliber stools, intermittent rectal pain, and occasional rectal bleeding. Workup includes history and physical exam, anoscopy or flexible sigmoidoscopy to visualize the stricture, and imaging (contrast enema or pelvic MRI) when malignancy or complex stricture is suspected. Biopsy is performed if a tumor is suspected. After conservative measures (dilatation, topical therapy) fail or when the stricture is fixed or secondary to scar tissue or tumor, the surgeon schedules a operative procedure for surgical division or incision of the rectal stricture under appropriate anesthesia. The procedure may be done in an operating room or ambulatory surgical center; intraoperative steps include identification of the stricture, careful incision and scar excision as indicated, hemostasis, and assessment of lumen patency. Postoperative workflow includes pain control, stool softeners, activity restrictions, wound or anorectal care, and follow-up endoscopic or clinical evaluation to monitor healing and recurrence. Typical provider specialties involved are colorectal surgery, general surgery with colorectal expertise, and sometimes gastroenterology for pre- and post-procedure evaluation.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier specified	Rarely appended; indicates standard service as billed

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

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

CPT 45120: Abdominoperineal Rectal Resection with Colon-Anus Anastomosis

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

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

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

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

CPT-45123-PERINEAL-RECTAL-RESECTION-WITHOUT-ANASTOMOSIS

CPT 45123: Perineal Resection of Diseased Rectum, No Anastomosis

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

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45121: Pull-Through Resection with Colorectal Anastomosis

CPT-45130-PERINEAL-RECTAL-PROLAPSE-EXCISION-REANASTOMOSIS

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

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

CPT 45112: Rectal Resection with Colonic Anastomosis to Anus

CPT-45108-ANORECTAL-TUMOR-EXCISION

CPT 45108: Excision of Anorectal Muscle Tumor

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Taxonomy Code	Specialty	Notes
`207RX0200X`	Colon and Rectal Surgery	Primary specialty performing this procedure
`207L00000X`	General Surgery	General surgeons with colorectal experience commonly perform this procedure
`2080S0112X`	Gastroenterology	Provides diagnostic and nonsurgical management; may refer and perform endoscopic dilations
`363LF0000X`	Surgical Oncology	In cases where rectal tumor or malignancy is the stricture cause
`207K00000X`	Family Medicine	May be involved in initial presentation and referral

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Anal and rectal polyp	Polyps near the anorectal junction can cause localized narrowing or require excision contributing to stricture management
`K60.3`	Fissure and fistula of anal canal and rectum	Chronic inflammatory changes and scarring from fissures/fistulae may lead to strictures requiring surgical incision
`K50.919`	Crohn's disease, unspecified, without complications	Chronic inflammatory bowel disease such as Crohn disease commonly causes fibrostenotic strictures in the rectum or distal colon
`K51.919`	Ulcerative colitis, unspecified, without complications	Longstanding ulcerative colitis may cause rectal scarring and stricturing necessitating surgical intervention
`C20`	Malignant neoplasm of rectum	Rectal tumors can cause intrinsic or extrinsic narrowing; surgical division may be palliative or preparatory to resection
`K59.0`	Constipation	Severe chronic constipation with resultant scarring or obstructive symptoms can be associated with evaluation and treatment of rectal strictures
`I84.9`	Hemorrhoids, unspecified	Advanced hemorrhoidal disease and prior interventions can cause scarring and stricture formation in the anorectal canal

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Common diagnostic endoscopic evaluation performed before deciding on surgical division of a rectal stricture
`45378`	Colonoscopy, flexible; with biopsy, single or multiple	Used preoperatively to evaluate for causes of stricture and to obtain diagnostic tissue when tumor is suspected
`45380`	Colonoscopy with removal of tumor(s), polypectomy by snare or cautery	Performed if polypectomy or tumor debulking is indicated in same setting or prior to definitive stricture surgery
`46240`	Excision of lesion of anus, simple; less than 1.5 cm	May be performed concurrently if perianal lesions contribute to obstruction or for biopsy/excision near the anal verge
`49560`	Repair initial incisional or ventral hernia; reducible	Data not available in the input.

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