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See a sample rate comparisonCPT 45126 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Pelvic Exenteration, Pelvic Exenteration For Colorectal Malignancy With Proctectomy With Or Without Colostomy With Removal Of Bladder And Ureteral Transplantations And Or Hysterectomy Or Cervicectomy With Or Without Removal Of Tube S With Or Without Removal Of Ovary S Or Any Combination Thereof
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital None 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 62 - Co-Surgeons 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 45126 |
| Medicaid Fee Schedule | View Medicaid rates for 45126 |
National average reimbursement for CPT 45126 by major payers:
$3,427.48
$3,724.70
$3,864.74
$4,430.67
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CPT 45126
5 of 25 sample ratesHigher to lower in this preview
Lake George Surgery Center, LLC
$2,888.00Published ratePort Jefferson Asc, LLC
Port Jefferson Asc LLC
$1,040.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Phoenix
Surgery Center Of Scottsdale LLC
$809.00Published ratePremier Physicians Centers, Inc
Premier Physicians Centers, Inc.
$424.00Published rateBuckeye South LLC, Buckeye Surgery Center
Buckeye South LLC
$92.00Published rate
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See a sample payer proposalCPT 45126 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 45126 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 45126 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 45111-CPT | High | Partial Removal Of The Rectum, Surgical Removal Of A Portion Of The Rectum. The Remaining Healthy Segments Of The Rectum Are Reconnected. |
| 45121-CPT | High | Removal Of Rectum And Colon, Proctectomy Complete For Congenital Megacolon Abdominal And Perineal Approach With Subtotal Or Total Colectomy With Multiple Biopsies |
| 45126-CPT | High | Pelvic Exenteration, Pelvic Exenteration For Colorectal Malignancy With Proctectomy With Or Without Colostomy With Removal Of Bladder And Ureteral Transplantations And Or Hysterectomy Or Cervicectomy With Or Without Removal Of Tube S With Or Without Removal Of Ovary S Or Any Combination Thereof |
| 45130-CPT | High | Remove Rectum Out Of Anus, Removal Of Complete Rectal Prolapse (Condition Where Wall Of Rectum Falls Out Of Place And Protrudes From Anus). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 45126. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 45126 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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