CPT code 46020: Seton placement, anal fistula2026 Medicare rate & RVUs in Arkansas
Reports placement of a loop through an anal fistula tract to maintain drainage, often as part of staged management of complex fistula disease.
In Arkansas, Medicare pays $99.64 for 46020 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 46020 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 46020 covers
A surgeon passes a loop through an anal fistula tract and secures it so the tract remains open for drainage. Colorectal and general surgeons commonly perform this procedure for fistulas managed in stages, including situations where immediate division of the tract is not the treatment plan. It is performed in an operating room or other procedural setting, depending on the patient and clinical circumstances.
Report 46020 for placing the seton, not for removing one or draining an abscess alone. The operative note should identify the fistula tract and document the seton placement. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery reporting are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Arkansas compares for 46020
Across 109 of 109 payment localities, the facility rate for 46020 runs from $99.64 in Arkansas to $138.22 in Alaska. Arkansas pays $99.64. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Arkansas · this page$99.64
- Los Angeles, CA · California$116.36+$16.72
- Washington, DC area · District of Columbia$122.35+$22.71
- Miami, FL · Florida$130.85+$31.21
- Chicago, IL · Illinois$127.08+$27.44
- Manhattan, NY · New York$128.03+$28.39
- Alaska · Alaska$138.22+$38.58
Other areas in Arkansas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $100.87 |
| ArizonaArizona | — | $107.97 |
| Bakersfield, CACalifornia | — | $111.03 |
| Chico, CACalifornia | — | $110.03 |
| El Centro, CACalifornia | — | $110.09 |
| Fresno, CACalifornia | — | $110.03 |
| Hanford, CACalifornia | — | $110.03 |
| Madera, CACalifornia | — | $110.03 |
| Merced, CACalifornia | — | $110.03 |
| Modesto, CACalifornia | — | $110.03 |
| Napa, CACalifornia | — | $121.00 |
| Oxnard, CACalifornia | — | $115.04 |
| Redding, CACalifornia | — | $110.03 |
| Rest of CaliforniaCalifornia | — | $110.03 |
| Riverside, CACalifornia | — | $113.90 |
| Sacramento, CACalifornia | — | $113.75 |
| Salinas, CACalifornia | — | $113.29 |
| San Diego, CACalifornia | — | $114.73 |
| Marin County, CACalifornia | — | $125.88 |
| San Francisco, CACalifornia | — | $125.47 |
| San Benito County, CACalifornia | — | $128.94 |
| Santa Clara County, CACalifornia | — | $127.27 |
| San Luis Obispo, CACalifornia | — | $111.68 |
| Santa Cruz, CACalifornia | — | $114.84 |
| Santa Maria, CACalifornia | — | $113.38 |
| Santa Rosa, CACalifornia | — | $115.88 |
| Stockton, CACalifornia | — | $110.03 |
| Vallejo, CACalifornia | — | $120.41 |
| Visalia, CACalifornia | — | $110.03 |
| Yuba City, CACalifornia | — | $110.03 |
| ColoradoColorado | — | $111.44 |
| ConnecticutConnecticut | — | $117.58 |
| DelawareDelaware | — | $109.52 |
| Fort Lauderdale, FLFlorida | — | $121.11 |
| Rest of FloridaFlorida | — | $115.25 |
| Atlanta, GAGeorgia | — | $114.10 |
| Rest of GeorgiaGeorgia | — | $109.05 |
| Hawaii, Guam, HIHawaii | — | $111.09 |
| IowaIowa | — | $100.38 |
| IdahoIdaho | — | $101.48 |
| East St. Louis, ILIllinois | — | $120.01 |
| Rest of IllinoisIllinois | — | $114.32 |
| Suburban Chicago, ILIllinois | — | $121.63 |
| IndianaIndiana | — | $101.91 |
| KansasKansas | — | $101.24 |
| KentuckyKentucky | — | $105.61 |
| New Orleans, LALouisiana | — | $110.26 |
| Rest of LouisianaLouisiana | — | $105.97 |
| Metropolitan Boston, MAMassachusetts | — | $119.50 |
| Rest of MassachusettsMassachusetts | — | $111.45 |
| Baltimore area, MDMaryland | — | $117.51 |
| Rest of MarylandMaryland | — | $110.97 |
| Rest of MaineMaine | — | $103.27 |
| Southern Maine, MEMaine | — | $106.11 |
| Detroit, MIMichigan | — | $117.80 |
| Rest of MichiganMichigan | — | $109.10 |
| MinnesotaMinnesota | — | $103.54 |
| Metropolitan Kansas City, MOMissouri | — | $108.27 |
| Metropolitan St. Louis, MOMissouri | — | $109.07 |
| Rest of MissouriMissouri | — | $105.28 |
| MississippiMississippi | — | $102.41 |
| MontanaMontana | — | $110.87 |
| North CarolinaNorth Carolina | — | $103.98 |
| North DakotaNorth Dakota | — | $103.75 |
| NebraskaNebraska | — | $100.45 |
| New HampshireNew Hampshire | — | $110.96 |
| Northern New JerseyNew Jersey | — | $121.66 |
| Rest of New JerseyNew Jersey | — | $118.01 |
| New MexicoNew Mexico | — | $110.12 |
| NevadaNevada | — | $108.92 |
| NYC suburbs and Long Island, NYNew York | — | $132.32 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $119.79 |
| Queens, NYNew York | — | $127.07 |
| Rest of New YorkNew York | — | $105.40 |
| OhioOhio | — | $107.65 |
| OklahomaOklahoma | — | $104.10 |
| Portland, OROregon | — | $113.04 |
| Rest of OregonOregon | — | $107.17 |
| Metropolitan Philadelphia, PAPennsylvania | — | $115.87 |
| Rest of PennsylvaniaPennsylvania | — | $107.08 |
| Puerto RicoPuerto Rico | — | $111.13 |
| Rhode IslandRhode Island | — | $112.01 |
| South CarolinaSouth Carolina | — | $106.17 |
| South DakotaSouth Dakota | — | $102.91 |
| TennesseeTennessee | — | $101.83 |
| Austin, TXTexas | — | $111.87 |
| Beaumont, TXTexas | — | $106.58 |
| Brazoria, TXTexas | — | $108.38 |
| Dallas, TXTexas | — | $109.57 |
| Fort Worth, TXTexas | — | $109.35 |
| Galveston, TXTexas | — | $109.04 |
| Houston, TXTexas | — | $115.63 |
| Rest of TexasTexas | — | $107.77 |
| UtahUtah | — | $107.36 |
| VirginiaVirginia | — | $106.70 |
| Virgin Islands, VIUnited States Virgin Islands | — | $111.13 |
| VermontVermont | — | $104.57 |
| Rest of WashingtonWashington | — | $110.84 |
| King County, WAWashington | — | $120.43 |
| WisconsinWisconsin | — | $100.96 |
| West VirginiaWest Virginia | — | $111.04 |
| WyomingWyoming | — | $107.76 |
46020 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 46020 rate is calculated
Each of 46020’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46020
RVUs × geographic indexes × conversion factor
Work1.81
1.81 RVUs× 1.000 GPCI
Practice expense1.15
1.15 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
3.3200
Conversion factor
$33.4009
Medicare rate
$110.89
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Arkansas inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,570
- Code
- 46020
- Physician work
- 1.81
- Practice expense
- 1.15
- Malpractice
- 0.36
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.81 | × 1.000 | 1.8100 |
| Practice expense | 1.15 | × 0.859 | 0.9878 |
| Malpractice | 0.36 | × 0.515 | 0.1854 |
| Total RVUs | 2.9832 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$99.64
Facility: (1.81 × 1 + 1.15 × 0.859 + 0.36 × 0.515) × $33.4009 = $99.64
Payment rules and modifiers for 46020
The CMS indicators that decide how 46020 is paid alongside other services.
CMS payment indicators · 46020
Seton placement, anal fistula
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46020 without 51 · national facility
$110.89
Seton placement, anal fistula
46020-51 · Second procedure: 50%
$55.45
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 46020 has changed in Arkansas
46020 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2022
RVU22A
$258.69changed toNo rate
Held through RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2021
RVU21A
$259.91changed to$258.69
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 4.57 changed to 4.92
- Practice expense GPCI 0.859 changed to 0.847
- Malpractice GPCI 0.521 changed to 0.465
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$259.27changed to$259.91
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 4.44 changed to 4.57
- Malpractice RVU 0.56 changed to 0.53
- Practice expense GPCI 0.872 changed to 0.859
- Malpractice GPCI 0.576 changed to 0.521
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$257.11changed to$259.27
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 4.38 changed to 4.44
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$254.84changed to$257.11
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 4.35 changed to 4.38
- Malpractice RVU 0.57 changed to 0.56
- Practice expense GPCI 0.870 changed to 0.872
- Malpractice GPCI 0.555 changed to 0.576
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$253.23changed to$254.84
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 4.34 changed to 4.35
- Malpractice RVU 0.58 changed to 0.57
- Practice expense GPCI 0.867 changed to 0.870
- Malpractice GPCI 0.534 changed to 0.555
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$254.50changed to$253.23
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 4.37 changed to 4.34
- Malpractice RVU 0.55 changed to 0.58
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$253.23changed to$254.50
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$250.96changed to$253.23
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 4.33 changed to 4.37
- Malpractice RVU 0.52 changed to 0.55
- Practice expense GPCI 0.866 changed to 0.867
- Malpractice GPCI 0.492 changed to 0.534
Held through RVU15B.
January 1, 2014
RVU14A
$253.37changed to$250.96
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 4.86 changed to 4.33
- Malpractice RVU 0.54 changed to 0.52
- Practice expense GPCI 0.865 changed to 0.866
- Malpractice GPCI 0.450 changed to 0.492
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $253.37
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $99.64 | RVU26D |
| 2026-07-01 | Not available in this setting | $99.64 | RVU26C |
| 2026-04-01 | Not available in this setting | $99.64 | RVU26B |
| 2026-01-01 | Not available in this setting | $99.64 | RVU26A |
| 2025-10-01 | Not available in this setting | $102.75 | RVU25D |
| 2025-07-01 | Not available in this setting | $102.75 | RVU25C |
| 2025-04-01 | Not available in this setting | $102.75 | RVU25B |
| 2025-01-01 | Not available in this setting | $102.75 | RVU25A |
| 2024-10-01 | Not available in this setting | $104.88 | RVU24D |
| 2024-07-01 | Not available in this setting | $104.88 | RVU24C |
| 2024-04-01 | Not available in this setting | $104.88 | RVU24B |
| 2024-03-09 | Not available in this setting | $104.88 | RVU24AR |
| 2024-01-01 | Not available in this setting | $103.17 | RVU24A |
| 2023-10-01 | Not available in this setting | $105.29 | RVU23D |
| 2023-07-01 | Not available in this setting | $105.29 | RVU23C |
| 2023-04-01 | Not available in this setting | $105.29 | RVU23B |
| 2023-01-01 | Not available in this setting | $105.29 | RVU23A |
| 2022-10-01 | Not available in this setting | $105.60 | RVU22D |
| 2022-07-01 | Not available in this setting | $105.60 | RVU22C |
| 2022-04-01 | Not available in this setting | $105.60 | RVU22B |
| 2022-01-01 | Not available in this setting | $105.60 | RVU22A |
| 2021-10-01 | $258.69 | $216.72 | RVU21D |
| 2021-07-01 | $258.69 | $216.72 | RVU21C |
| 2021-04-01 | $258.69 | $216.72 | RVU21B |
| 2021-01-01 | $258.69 | $216.72 | RVU21A |
| 2020-10-01 | $259.91 | $220.23 | RVU20D |
| 2020-07-01 | $259.91 | $220.23 | RVU20C |
| 2020-04-01 | $259.91 | $220.23 | RVU20B |
| 2020-01-01 | $259.91 | $220.23 | RVU20A |
| 2019-10-01 | $259.27 | $221.25 | RVU19D |
| 2019-07-01 | $259.27 | $221.25 | RVU19C |
| 2019-04-01 | $259.27 | $221.25 | RVU19B |
| 2019-01-01 | $259.27 | $221.25 | RVU19A |
| 2018-10-01 | $257.11 | $220.38 | RVU18D |
| 2018-07-01 | $257.11 | $220.38 | RVU18C |
| 2018-04-01 | $257.11 | $220.38 | RVU18B |
| 2018-01-01 | $257.11 | $220.38 | RVU18AR1 |
| 2017-10-01 | $254.84 | $218.31 | RVU17D |
| 2017-07-01 | $254.84 | $218.31 | RVU17C |
| 2017-04-01 | $254.84 | $218.31 | RVU17B |
| 2017-01-01 | $254.84 | $218.31 | RVU17A |
| 2016-10-01 | $253.23 | $217.22 | RVU16D |
| 2016-07-01 | $253.23 | $217.22 | RVU16C |
| 2016-04-01 | $253.23 | $217.22 | RVU16B |
| 2016-01-01 | $253.23 | $217.22 | RVU16A |
| 2015-10-01 | $254.50 | $218.05 | RVU15D |
| 2015-07-01 | $254.50 | $218.05 | RVU15C |
| 2015-04-01 | $253.23 | $216.96 | RVU15B |
| 2015-01-01 | $253.23 | $216.96 | RVU15A |
| 2014-10-01 | $250.96 | $215.28 | RVU14D |
| 2014-07-01 | $250.96 | $215.28 | RVU14C |
| 2014-04-01 | $250.96 | $215.28 | RVU14B |
| 2014-01-01 | $250.96 | $215.28 | RVU14A |
| 2013-10-01 | $253.37 | $214.81 | RVU13D |
| 2013-07-01 | $253.37 | $214.81 | RVU13C |
| 2013-04-01 | $253.37 | $214.81 | RVU13B |
| 2013-01-01 | $253.37 | $214.81 | RVU13AR |
Where the Arkansas rate applies
Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.
- Acorn
- Adona
- Alexander
- Alicia
- Alix
- Alleene
- Allport
- Alma
46020 billing questions
How does seton placement differ from fistulotomy?
46020 reports placement of a loop to keep the fistula tract draining. A fistulotomy code describes opening the tract as the operative treatment, rather than placing a seton.
Can an abscess drainage code also be reported?
A separate abscess drainage service may be relevant when an abscess is also treated, but the documentation should support that distinct work. Seton placement alone does not describe abscess drainage.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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