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    v1.0.30
    OpenPayerBilling CodesExcisional Laparoscopic Procedures on the RectumCPT cpt-45395-laparoscopic-total-proctectomy-end-colostomy
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    CPT 45395: Laparoscopic Proctectomy with Colostomy

    Medicare pays $1824 on average nationally for this procedure.

    CPT code 45395 describes a laparoscopic proctectomy with colostomy in which the provider performs a complete rectal resection using a laparoscope and brings the remaining colon to the abdominal wall to create a permanent stoma; service type: surgical resection with stoma creation; typical site of service: inpatient hospital operating room or ambulatory surgery center.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 62-year-old with locally advanced rectal adenocarcinoma who presents after neoadjuvant chemoradiation with persistent tumor involving the rectum and perirectal tissues. After multidisciplinary review, the surgical team schedules a planned laparoscopic abdominoperineal resection with end colostomy creation. The patient undergoes preoperative bowel preparation, anesthesia evaluation, and perioperative antibiotics. In the operating room, the colorectal surgeon performs a laparoscopic total proctectomy, mobilizes the sigmoid colon, divides the rectum and anus, and matures a permanent end colostomy on the abdominal wall. Postoperative workflow includes recovery in post-anesthesia care, pain management, early ambulation, ostomy teaching by Wound, Ostomy, and Continence (WOC) nurses, and inpatient monitoring for return of bowel function and wound healing. Typical sites of service are the inpatient hospital operating room and post-anesthesia/postoperative units. The service type is a major surgical procedure (laparoscopic proctectomy with colostomy) typically billed as surgical inpatient care.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    44143Colectomy, partial; with colostomy or ileostomy (separate procedure)May be performed if additional proximal colon resection is required or as part of an extended oncologic colectomy.
    44204Laparoscopy, surgical; colectomy, partial, with colostomy or ileostomyLaparoscopic partial colectomy codes apply when resections extend proximally and a stoma is created via minimally invasive approach.
    49650Closure of enterostomy; complicatedMay be billed in a later admission when the colostomy is reversed (closure), if indicated.
    44625Closure of partial colectomy with primary anastomosisApplies when restoration of intestinal continuity is performed in a subsequent surgery instead of permanent colostomy.
    99223Initial hospital care, typically 70 minutes or moreTypical inpatient evaluation and management code for preoperative or immediate postoperative complex medical care for major surgery.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    208800000X
    2080P0205X
    207L00000X
    2084P0800X
    2080P0208X
    310400000X
    261QR0800X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-45397-LAPAROSCOPIC-PROCTOCOLECTOMY-COLOANAL-ANASTOMOSIS-COLONIC-POUCH

    CPT 45397: Laparoscopic Restorative Proctocolectomy with Ileoanal Pouch

    CPT-45398-COLONOSCOPY-BAND-LIGATION-HEMORRHOID

    CPT 45398: Flexible Colonoscopy with Band Ligation

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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