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CPT code 46040: Abscess drainage, ischiorectal or intramural2026 Medicare rate & RVUs in Queens, NY

Reports external incision and drainage of an ischiorectal or intramural abscess, where the abscess location distinguishes it from superficial perianal drainage.

CMS RVU26DEffective Oct 1, 2026One payment locality3.3K Medicare services in 2024

In Queens, NY, Medicare pays $734.75 for 46040 in the office and $503.80 when it’s performed in a hospital or facility.

$734.75Office (non-facility)
$503.80Hospital or facility
+16.6%vs the national office rate ($630.27)

Check a contract rate as a % of Medicare · 46040 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 46040 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 46040 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 46040 covers

This operation drains an abscess in the ischiorectal space or within the rectal wall through an external incision. A general or colorectal surgeon typically performs it in an operating room or, when clinically appropriate, another procedure setting. The surgeon opens the infected cavity, evacuates its contents, and provides drainage; the operative note should identify the abscess location and approach.

Select the code based on the documented site and procedure, not simply the diagnosis of anorectal abscess. A superficial perianal collection or a transanal drainage approach points to a different code; when fistula surgery accompanies drainage, consider the code that includes that work. Medicare treats this as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 Queens, NY compares for 46040

Across 109 of 109 payment localities, the office rate for 46040 runs from $552.30 in Arkansas to $814.44 in San Benito County, CA. Queens, NY pays $734.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

46040 in Queens, NY vs other payment areas
  1. Queens, NY · this page$734.75
  2. Manhattan, NY · New York$732.22−$2.53
  3. NYC suburbs and Long Island, NY · New York$754.29+$19.54
  4. Poughkeepsie and northern NYC suburbs, NY · New York$686.01−$48.74
  5. Rest of New York · New York$597.61−$137.14
  6. Los Angeles, CA · California$699.96−$34.79
  7. Washington, DC area · District of Columbia$718.16−$16.59

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

46040 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$708.58$505.17
Chicago, ILIllinois$685.48$489.11
AlaskaAlaska$726.78$518.68
AlabamaAlabama$560.98$390.01
ArkansasArkansas$552.30$384.45
ArizonaArizona$611.63$422.29
Bakersfield, CACalifornia$657.79$443.63
Chico, CACalifornia$654.51$440.36

46040 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$552.30

$734.48

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
46040 office rate range by state
State / territoryOffice rate rangeLocalities
AK$726.781
AL$560.981
AR$552.301
AZ$611.631
CA$654.51–$814.4429
CO$650.171
CT$674.161
DC$718.161
DE$622.121
FL$632.17–$708.583
GA$593.13–$645.502
GU$670.281
HI$670.281
IA$570.821
ID$575.941
IL$616.72–$685.484
IN$579.371
KS$570.541
KY$580.781
LA$580.85–$611.232
MA$646.94–$713.592
MD$633.72–$718.163
ME$581.91–$611.752
MI$599.33–$643.242
MN$614.101
MO$571.94–$610.433
MS$562.101
MT$630.191
NC$587.991
ND$606.471
NE$573.381
NH$642.291
NJ$679.36–$710.452
NM$603.871
NV$624.001
NY$597.61–$754.295
OH$594.481
OK$576.911
OR$616.71–$668.902
PA$594.03–$658.182
PR$634.241
RI$642.971
SC$592.711
SD$603.661
TN$573.941
TX$590.06–$650.148
UT$601.281
VA$611.43–$718.162
VI$634.241
VT$606.321
WA$644.98–$725.942
WI$585.101
WV$593.161
WY$619.851

See 46040 in every payment locality

How the 46040 rate is calculated

Each of 46040’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 · 46040

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.24

5.24 RVUs× 1.000 GPCI

Practice expense12.43

12.43 RVUs× 1.000 GPCI

Malpractice1.20

1.20 RVUs× 1.000 GPCI

Adjusted RVUs

18.8700

Conversion factor

$33.4009

Medicare rate

$630.27

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,572

Code
46040
Physician work
5.24
Practice expense
12.43
Malpractice
1.20

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 46040 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work5.24× 1.0645.5754
Practice expense12.43× 1.18214.6923
Malpractice1.20× 1.4421.7304
Total RVUs21.9980
Conversion factor× 33.4009

Office rate, Queens, NY$734.75

Office: (5.24 × 1.064 + 12.43 × 1.182 + 1.2 × 1.442) × $33.4009 = $734.75

Facility: (5.24 × 1.064 + 6.58 × 1.182 + 1.2 × 1.442) × $33.4009 = $503.80

Open 46040 in the RVU calculator

Payment rules and modifiers for 46040

46040 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46040

Abscess drainage, ischiorectal or intramural

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 46040

Abscess drainage, ischiorectal or intramural

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46040 without 51 · national office

$630.27

Abscess drainage, ischiorectal or intramural

46040-51 · Second procedure: 50%

$315.14

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%).

When to use modifier 51

Codes related to 46040

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 46040
CodeHow it relatesOffice range, Queens, NY
Used instead
46045Abscess drainage, perirectal, under anesthesiaFor transanal drainage of a perirectal abscess under anesthesia rather than an external approach.No office rate
46050Perianal abscess drainage, superficial abscessFor drainage of a superficial perianal abscess, rather than a deeper ischiorectal or intramural collection.$313.15
46060Abscess drainage, with fistula treatmentIncludes abscess drainage with fistulectomy or fistulotomy when fistula surgery is performed.No office rate

How 46040 has changed in Queens, NY

46040 · Office / nonfacility

$734.75

Effective 2026-10-01

The base rate is $95.30 higher than on 2025-10-01, moving from $639.45 to $734.75 (14.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $639.45changed to$734.75

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.37 changed to 5.24
    • Practice expense RVU 10.35 changed to 12.43
    • Malpractice RVU 1.15 changed to 1.20
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $653.45changed to$639.45

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.21 changed to 10.35
    • Malpractice RVU 1.17 changed to 1.15

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $642.79changed to$653.45

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $691.33changed to$642.79

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 1.13 changed to 1.17
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $739.08changed to$691.33

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.26 changed to 10.21
    • Malpractice RVU 1.16 changed to 1.13
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $738.06changed to$739.08

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.18 changed to 10.26
    • Malpractice RVU 1.12 changed to 1.16

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $706.17changed to$738.06

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.23 changed to 10.18
    • Malpractice RVU 1.13 changed to 1.12
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $678.86changed to$706.17

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.01 changed to 9.23
    • Malpractice RVU 1.12 changed to 1.13
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $675.96changed to$678.86

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.96 changed to 9.01

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $669.91changed to$675.96

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.84 changed to 8.96
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $669.57changed to$669.91

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.83 changed to 8.84
    • Malpractice RVU 1.13 changed to 1.12
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $672.15changed to$669.57

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.87 changed to 8.83
    • Malpractice RVU 1.11 changed to 1.13

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $668.80changed to$672.15

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $640.44changed to$668.80

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.66 changed to 8.87
    • Malpractice RVU 1.00 changed to 1.11
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $643.71changed to$640.44

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.75 changed to 8.66
    • Malpractice RVU 1.05 changed to 1.00
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $643.71

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$734.75$503.80RVU26D
2026-07-01$734.75$503.80RVU26C
2026-04-01$734.75$503.80RVU26B
2026-01-01$734.75$503.80RVU26A
2025-10-01$639.45$492.17RVU25D
2025-07-01$639.45$492.17RVU25C
2025-04-01$639.45$492.17RVU25B
2025-01-01$639.45$492.17RVU25A
2024-10-01$653.45$500.30RVU24D
2024-07-01$653.45$500.30RVU24C
2024-04-01$653.45$500.30RVU24B
2024-03-09$653.45$500.30RVU24AR
2024-01-01$642.79$492.14RVU24A
2023-10-01$691.33$529.92RVU23D
2023-07-01$691.33$529.92RVU23C
2023-04-01$691.33$529.92RVU23B
2023-01-01$691.33$529.92RVU23A
2022-10-01$739.08$566.54RVU22D
2022-07-01$739.08$566.54RVU22C
2022-04-01$739.08$566.54RVU22B
2022-01-01$739.08$566.54RVU22A
2021-10-01$738.06$561.52RVU21D
2021-07-01$738.06$561.52RVU21C
2021-04-01$738.06$561.52RVU21B
2021-01-01$738.06$561.52RVU21A
2020-10-01$706.17$549.75RVU20D
2020-07-01$706.17$549.75RVU20C
2020-04-01$706.17$549.75RVU20B
2020-01-01$706.17$549.75RVU20A
2019-10-01$678.86$529.23RVU19D
2019-07-01$678.86$529.23RVU19C
2019-04-01$678.86$529.23RVU19B
2019-01-01$678.86$529.23RVU19A
2018-10-01$675.96$526.49RVU18D
2018-07-01$675.96$526.49RVU18C
2018-04-01$675.96$526.49RVU18B
2018-01-01$675.96$526.49RVU18AR1
2017-10-01$669.91$523.92RVU17D
2017-07-01$669.91$523.92RVU17C
2017-04-01$669.91$523.92RVU17B
2017-01-01$669.91$523.92RVU17A
2016-10-01$669.57$524.47RVU16D
2016-07-01$669.57$524.47RVU16C
2016-04-01$669.57$524.47RVU16B
2016-01-01$669.57$524.47RVU16A
2015-10-01$672.15$524.80RVU15D
2015-07-01$672.15$524.80RVU15C
2015-04-01$668.80$522.19RVU15B
2015-01-01$668.80$522.19RVU15A
2014-10-01$640.44$499.37RVU14D
2014-07-01$640.44$499.37RVU14C
2014-04-01$640.44$499.37RVU14B
2014-01-01$640.44$499.37RVU14A
2013-10-01$643.71$491.65RVU13D
2013-07-01$643.71$491.65RVU13C
2013-04-01$643.71$491.65RVU13B
2013-01-01$643.71$491.65RVU13AR

Price 46040 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

46040 billing questions

How is 46040 distinguished from superficial perianal abscess drainage?

Use 46040 for an ischiorectal-space or intramural abscess drained through an external incision. A superficial perianal collection is described by 46050.

When is 46045 a better choice?

46045 describes transanal drainage of a perirectal abscess under anesthesia. For 46040, the operative documentation should support an external approach to an ischiorectal or intramural abscess.

Can 46040 be reported with 46060?

When the surgeon treats an associated fistula with fistulectomy or fistulotomy during abscess drainage, consider 46060, which includes that additional work. Do not report both codes for the same drainage service.

What documentation supports 46040?

The operative report should identify the abscess as ischiorectal or intramural and describe the external incision, drainage, and cavity findings. A generic diagnosis of anorectal abscess alone does not establish the site or approach.

Can modifier 50 or an assistant-at-surgery claim be used?

Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 46040.

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
RVUs for 46040PPRRVU2026_Oct_nonQPP.csv, line 5,572 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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