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CPT 45190: Transanal Destruction of Rectal Tumor

CPT code 45190 identifies transanal destruction of a rectal tumor using techniques such as electrodesiccation, electrosurgery, laser ablation or resection, and cryosurgery. This procedure code is important for surgical, oncologic and colorectal service lines because it captures minimally invasive tumor destruction in the distal large intestine and drives facility and professional billing for these targeted interventions. Nationally, accurate use of this code affects claims processing, quality measurement, and aggregated utilization tracking for rectal tumor management.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for transanal tumor destruction, common settings where the procedure is performed, and the billing and coding elements that influence coverage and reimbursement. The publication summarizes benchmark metrics, common modifier usage, and payer coverage patterns where available, and it highlights policy considerations relevant to hospital and ambulatory surgery billing workflows. The content is intended to support coding accuracy, claims preparation, and administrative planning for providers and billing teams working in colorectal, surgical oncology, and procedural gastroenterology service lines.

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Billing Code Overview

CPT code 45190 describes destruction of a tumor in the rectum performed via a transanal approach through the anus. The procedure may use methods such as electrodesiccation, electrosurgery, laser ablation, laser resection, or cryosurgery to eliminate the lesion.

Service type: Surgical destruction of rectal tumor via transanal approach
Typical site of service: Ambulatory surgery center or hospital operating room, performed transanally

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CPT 45190: Transanal Destruction of Rectal Tumor

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Billing Code Overview

Service type: Surgical destruction of rectal tumor via transanal approach
Typical site of service: Ambulatory surgery center or hospital operating room, performed transanally

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old individual presenting with rectal bleeding, change in bowel habits, or a palpable rectal mass on digital rectal exam. After endoscopic evaluation (flexible sigmoidoscopy or colonoscopy) identifies a localized rectal tumor or premalignant lesion within reach of a transanal approach, the patient is scheduled for a transanal tumor destruction procedure. The patient undergoes preoperative assessment, informed consent, and bowel preparation as indicated. In the operating room or procedure suite, the patient is positioned in lithotomy or prone jackknife position. Under appropriate anesthesia (conscious sedation or general), a transanal approach is used to visualize the lesion with anoscope or proctoscope. The provider selects a destruction modality—electrodesiccation, electrosurgery, laser ablation/resection, or cryosurgery—based on lesion size, depth, and location. Hemostasis is achieved and specimens are sent for pathology if resection fragments are obtained. Post-procedure monitoring occurs in the recovery area with discharge instructions for analgesia, wound care, and follow-up with pathology and colorectal surgery. Typical site of service is an ambulatory surgery center or hospital operating room. Service type: invasive surgical/procedural destruction of rectal tumor via transanal approach.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for `45190` (document specific reasons).
`23`	Unusual anesthesia	Use when procedure ordinarily performed with local/regional anesthesia but general anesthesia is required for `45190`.
`26`	Professional component	Use when reporting only the professional component of a service (e.g., interpretation-only billing applicable to related imaging or pathology components).
`52`	Reduced services	Use when `45190` is partially performed or aborted, without full intended destruction.
`53`	Discontinued procedure	Use when procedure is terminated after anesthesia begins for reasons unrelated to patient condition.
`59`	Distinct procedural service	Use when another distinct procedure is performed in a separate anatomic site or session and documentation supports distinct service.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during `45190` for increased complexity.
`63`	Procedure performed on infants less than 4 kg	Use when applicable by patient weight; rare for rectal tumor destruction but included per CMS list.
`78`	Unplanned return to OR following prior procedure	Use when patient returns to the operating room for a related procedure following `45190` during the postoperative global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of `45190` and billing requires assistant surgeon reporting.
`81`	Minimum assistant surgeon	Use when minimal assistant involvement is documented for `45190`.
`82`	Assistant surgeon when qualified resident unavailable	Use when a nonphysician assistant is used due to lack of qualified resident.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician serves as assistant for `45190` where allowed.
`59`	Separate and distinct service (listed again for emphasis)	Use when documentation clearly supports separate anatomic or distinct procedural service on same date as `45190`.

Taxonomy Code	Specialty	Notes
`207VC0000X`	Colon and Rectal Surgery	Primary specialty performing `45190`; includes surgical management of rectal tumors.
`207L00000X`	General Surgery	General surgeons perform transanal tumor destruction in appropriate cases.
`208000000X`	Gastroenterology	Gastroenterologists may perform transanal procedures endoscopically or assist with localization and biopsy.
`363L00000X`	Family Medicine	In limited settings, family medicine proceduralists may perform minor transanal interventions; referral common.
`207X00000X`	Surgical Oncology	Surgical oncologists involved when tumor requires oncologic planning and multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	Rectal bleeding may prompt evaluation leading to identification and transanal destruction of a rectal lesion.
`K62.9`	Disease of anus and rectum, unspecified	General code sometimes used when specific rectal lesion diagnosis is pending.
`D12.6`	Benign neoplasm of rectum	Common indication for localized transanal destruction when lesion is benign and accessible.
`C20`	Malignant neoplasm of rectum	Early localized rectal cancer may be treated with transanal destructive techniques in select cases.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Incidental colonic pathology identified on evaluation; may coexist but not typically treated with `45190`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen by brushing or washing	Performed preoperatively for visualization and biopsy prior to `45190`.
`45380`	Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing	Used for diagnostic evaluation of colonic pathology and lesion localization before transanal destruction.
`45191`	Transanal excision of tumor, benign; lesions of the rectum (alternate/add-on for excision vs destruction)	May be performed when full transanal excision (resection) is chosen instead of destructive techniques in `45190`.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used when tissue obtained during or after `45190` is submitted for pathology evaluation.
`99152`	Moderate sedation services provided by the same physician performing the procedure (first 30 minutes)	Billed when moderate sedation is administered by the physician during `45190` if payer allows separate reporting.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for `45190` (document specific reasons).
`23`	Unusual anesthesia	Use when procedure ordinarily performed with local/regional anesthesia but general anesthesia is required for `45190`.
`26`	Professional component	Use when reporting only the professional component of a service (e.g., interpretation-only billing applicable to related imaging or pathology components).
`52`	Reduced services	Use when `45190` is partially performed or aborted, without full intended destruction.
`53`	Discontinued procedure	Use when procedure is terminated after anesthesia begins for reasons unrelated to patient condition.
`59`	Distinct procedural service	Use when another distinct procedure is performed in a separate anatomic site or session and documentation supports distinct service.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during `45190` for increased complexity.
`63`	Procedure performed on infants less than 4 kg	Use when applicable by patient weight; rare for rectal tumor destruction but included per CMS list.
`78`	Unplanned return to OR following prior procedure	Use when patient returns to the operating room for a related procedure following `45190` during the postoperative global period.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of `45190` and billing requires assistant surgeon reporting.
`81`	Minimum assistant surgeon	Use when minimal assistant involvement is documented for `45190`.
`82`	Assistant surgeon when qualified resident unavailable	Use when a nonphysician assistant is used due to lack of qualified resident.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician serves as assistant for `45190` where allowed.
`59`	Separate and distinct service (listed again for emphasis)	Use when documentation clearly supports separate anatomic or distinct procedural service on same date as `45190`.

Taxonomy Code	Specialty	Notes
`207VC0000X`	Colon and Rectal Surgery	Primary specialty performing `45190`; includes surgical management of rectal tumors.
`207L00000X`	General Surgery	General surgeons perform transanal tumor destruction in appropriate cases.
`208000000X`	Gastroenterology	Gastroenterologists may perform transanal procedures endoscopically or assist with localization and biopsy.
`363L00000X`	Family Medicine	In limited settings, family medicine proceduralists may perform minor transanal interventions; referral common.
`207X00000X`	Surgical Oncology	Surgical oncologists involved when tumor requires oncologic planning and multidisciplinary care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K62.5`	Hemorrhage of anus and rectum	Rectal bleeding may prompt evaluation leading to identification and transanal destruction of a rectal lesion.
`K62.9`	Disease of anus and rectum, unspecified	General code sometimes used when specific rectal lesion diagnosis is pending.
`D12.6`	Benign neoplasm of rectum	Common indication for localized transanal destruction when lesion is benign and accessible.
`C20`	Malignant neoplasm of rectum	Early localized rectal cancer may be treated with transanal destructive techniques in select cases.
`K57.30`	Diverticulosis of large intestine without perforation or abscess	Incidental colonic pathology identified on evaluation; may coexist but not typically treated with `45190`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45330`	Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen by brushing or washing	Performed preoperatively for visualization and biopsy prior to `45190`.
`45380`	Colonoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing	Used for diagnostic evaluation of colonic pathology and lesion localization before transanal destruction.
`45191`	Transanal excision of tumor, benign; lesions of the rectum (alternate/add-on for excision vs destruction)	May be performed when full transanal excision (resection) is chosen instead of destructive techniques in `45190`.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used when tissue obtained during or after `45190` is submitted for pathology evaluation.
`99152`	Moderate sedation services provided by the same physician performing the procedure (first 30 minutes)	Billed when moderate sedation is administered by the physician during `45190` if payer allows separate reporting.

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 45190: Transanal Destruction of Rectal Tumor

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Billing Code Overview

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CPT 45190: Transanal Destruction of Rectal Tumor

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

References