CPT 45905 Anal Canal Dilation Reimbursement | OpenPayer

Summary & Overview

CPT 45905: Manual Dilation of Anal Canal Stricture

CPT code 45905 denotes manual dilation of an anal canal stricture performed with the patient under anesthesia other than local anesthetic. Nationally, this code captures a focused, low- to moderate-complexity surgical intervention used to relieve obstructive symptoms from anal strictures and avoid more extensive reconstructive procedures. It is relevant across ambulatory surgical centers and hospital operating rooms where regional or general anesthesia is available.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, expected settings of care, and the payer landscape. The publication outlines common billing considerations, typical sites of service, and how this code is positioned relative to related surgical interventions. It also summarizes benchmarks and policy updates where available and highlights areas where practice patterns or payer policies commonly affect utilization and documentation.

This summary serves clinicians, coding professionals, and policy analysts who need a clear, national-level reference for CPT code 45905, its clinical purpose, and the payer environment that commonly governs coverage and billing for manual anal canal dilation under anesthesia.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare45905CPTanal dilationproctologysurgical procedureambulatory surgeryoperating roomanesthesia

Billing Code Overview

CPT code 45905 describes a procedure in which the provider manually dilates a stricture of the anal canal with the patient under anesthesia other than a local anesthetic. This procedure is a surgical anal dilatation intended to relieve symptomatic narrowing of the anal canal caused by scarring, fibrosis, or other obstructive pathology.

Service type: Surgical procedure (manual anal canal dilation)
Typical site of service: Operating room or ambulatory surgical center with the patient under regional or general anesthesia

Clinical & Coding Specifications

Clinical Context

An adult patient with progressive anal canal narrowing presents with difficulty passing stool, intermittent rectal pain, and recurrent fecal impaction. Conservative measures (fiber, stool softeners, topical therapy) have failed and digital examination demonstrates a tight, circumferential anal stricture. The patient is scheduled for an operative session under general or regional anesthesia to allow adequate relaxation and controlled manual dilation of the anal canal. Preoperative assessment includes evaluation for underlying causes (prior surgery, radiation, Crohn disease, chronic fissure), review of anticoagulation, informed consent documenting risks (bleeding, sphincter injury, incontinence), and anesthesia clearance. Intraoperative workflow involves positioning in the lithotomy or prone jackknife position, administration of anesthesia other than local (general endotracheal or monitored anesthesia care with regional block), and gentle progressive manual dilation by the surgeon using gloved fingers or appropriate dilators to stretch the stricture until a functional caliber is achieved. Post-procedure care includes pain control, stool softeners, instructions on gradual home dilation if indicated, and follow-up to monitor healing and sphincter function.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or initial service	Use when this is the primary, standard procedure performed by the reporting surgeon.

CPT 45915: Removal of Rectal Foreign Body or Fecal Impaction Under Anesthesia

CPT-45900-RECTAL-PROLAPSE-REDUCTION-UNDER-ANESTHESIA

CPT 45900: Reduction of Rectal Prolapse, Manual Under Anesthesia

CPT-45910-RECTAL-STRICTURE-DILATION-MANUAL

CPT 45910: Manual Dilation of Rectal Stricture

Taxonomy Code	Specialty	Notes
207P00000X	Colon and Rectal Surgery	Most common specialty performing anal stricture dilation.
207L00000X	Gastroenterology	Performs dilation in endoscopy suite or OR when indicated.
2080P0003X	General Surgery	Frequently performs anal surgery including manual dilation.
2084P0800X	Urology	May be involved if stricture management overlaps pelvic floor procedures.
207K00000X	Proctology (subset of colorectal)	Specialists focused on anorectal disease management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.2`	Fissure and fistula of anal and rectal regions	Anal fissures can lead to scarring and secondary stricture requiring dilation.
`K60.3`	Fissure of anus and anal canal, unspecified	Chronic fissure-related scarring may necessitate manual dilation.
`K62.1`	Anal stenosis	Direct indication for manual anal dilation to relieve narrowing.
`K60.0`	Abscess of anal and rectal regions	Prior abscess with scarring can produce stricture treated by dilation.
`K50.90`	Crohn disease, unspecified, without complications	Crohn-related anorectal disease may cause strictures requiring dilation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`45905`	Manual dilation of anal stricture under anesthesia other than local	Primary procedure: direct treatment of anal canal stricture by manual dilation.
`46900`	Excision of diseased hemorrhoid(s), internal and external; simple, 1st or 2nd degree	May be performed for coexisting anorectal pathology contributing to obstruction or pain.
`46910`	Hemorrhoidectomy, internal and external, combined, for 3 or more columns	Performed when extensive hemorrhoidal disease requires surgical management in the same operative session.
`45380`	Colonoscopy, flexible, diagnostic, with biopsy, single or multiple	Performed preoperatively or postoperatively to evaluate distal colon or mucosal disease contributing to stricture.
`46999`	Unlisted procedure, hemorrhoids and perirectal disease	Used for atypical anorectal procedures not described by specific codes when performed with dilation.
`49505`	Repair of recurrent pilonidal sinus with simple closure	Example of other perianal/perineal procedures that may be performed in the same operative encounter if clinically indicated.

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