CPT 45160 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

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

CPT code 45160 represents surgical excision of a rectal tumor through a posterior approach, either transsacral (through the sacrum) or transcoccygeal (through the coccyx). This procedure is clinically important for management of selected rectal and perirectal neoplasms where posterior access provides direct exposure. Nationally, the code is relevant to surgical oncology, colorectal surgery, and hospital and ambulatory surgical center billing practices.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical description and service context, followed by benchmarks and policy-relevant considerations where available. The publication outlines typical sites of service and procedural context, and it flags where input data are incomplete.

This analysis provides: (1) a clear clinical and coding definition of the service represented by CPT code 45160; (2) payer coverage scope used in the review; and (3) the types of benchmarks and policy or billing topics a reader can expect to find, such as utilization patterns, reimbursement benchmarks, coding guidance, and potential payer policy updates. Data not available in the input are noted explicitly, and no clinical or billing recommendations are provided.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicarecpt-45160cptrectal-surgerysurgical-oncologycolorectal-surgeryoperative-procedureambulatory-surgeryoperating-room

Billing Code Overview

CPT code 45160 describes a surgical procedure in which an incision is made in the rectum to excise a tumor. The procedure may be performed via a transsacral approach through the sacrum or a transcoccygeal approach through the coccyx.

Service Type: Surgical excision of rectal tumor (perirectal/transsacral/transcoccygeal approach)

Typical Site of Service: Operating room or ambulatory surgical center, with the anatomical focus at the rectum and surrounding posterior pelvic structures (sacrum or coccyx).

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a middle-aged adult presenting with a symptomatic rectal mass detected on digital rectal exam or imaging. The patient may report rectal bleeding, pain, change in bowel habits, or a palpable posterior midline mass. Preoperative workup includes colonoscopy with biopsy confirming a benign or malignant neoplasm localized to the posterior rectal wall or distal rectum, pelvic MRI or endorectal ultrasound for local staging, routine preoperative labs, and anesthesia clearance. The surgical team elects a transsacral or transcoccygeal approach to directly access and excise a posterior rectal tumor when transanal or abdominal approaches are unsuitable. The procedure is performed in an operating room under general or regional anesthesia with the patient prone. Intraoperative steps include positioning, a midline or parasacral incision, careful dissection through sacrococcygeal tissues (with partial sacrectomy or coccygectomy if needed), tumor excision with margin assessment, hemostasis, possible drain placement, and layered wound closure. Postoperative care includes pain control, wound care, monitoring for bleeding or infection, stool softeners, and follow-up for pathology results to guide any adjuvant therapy. Typical sites of service are an acute care hospital operating room or an ambulatory surgical center when clinically appropriate.

Coding Specifications

Modifier	Description	When to Use
`11`	Office or other outpatient visit for the evaluation and management service that is the same day as the procedure

CPT 45171: Transanal Local Excision of Rectal Tumor

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

CPT 45119: Restorative Proctocolectomy with Colonic Pouch

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

CPT 45136: Removal of Ileoanal Reservoir and Creation of Ileostomy

CPT-45150-RECTAL-STRICTURE-INCISION

CPT 45150: Incision of Rectal Stricture

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

CPT 45121: Pull-Through Resection with Colorectal Anastomosis

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

CPT 45126: Pelvic Exenteration for Advanced Colorectal and Genitourinary Cancer

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

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

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

CPT 45130: Perineal Excision and Reanastomosis for Rectal Procidentia

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

CPT 45100: Anal Approach Biopsy of Anorectal Wall

CPT-45110-ABDOMINOPERINEAL-RESECTION-WITH-COLOSTOMY

CPT 45110: Abdominoperineal Resection with Colostomy

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Taxonomy Code	Specialty	Notes
208100000X	Colon and Rectal Surgery	Primary specialty performing transsacral/transcoccygeal rectal tumor excision.
208000000X	General Surgery	General surgeons with colorectal focus may perform this procedure.
207L00000X	Surgical Oncology	Surgical oncologists perform resections of malignant rectal tumors and coordinate adjuvant care.
207K00000X	Otolaryngology/Head and Neck Surgery	Not typical; included only if rare sacral-coccygeal approach overlaps complex pelvic access (usually not applicable).
207RC0000X	Urology	Rarely involved for posterior pelvic lesions when multi-disciplinary approach is needed.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`44145`	Colectomy, partial; with anastomosis	May be performed when more extensive resection of rectosigmoid disease is required beyond local excision.
`45110`	Local excision of rectal lesion, transanal, single or multiple techniques	Alternative less-invasive approach for anterior or low rectal lesions when feasible; may be performed instead of transsacral excision.
`19301`	Mastectomy, partial (example unrelated)	Data not available in the input.
`36561`	Insertion of tunneled central venous catheter	May be performed preoperatively for patients requiring long-term IV access for chemotherapy planning (ancillary to oncologic care).
`23010`	Partial excision sacrum/coccyx (example)	Procedures involving coccygectomy or partial sacrectomy may be reported with appropriate sacral resection codes when required during access.

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