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

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 Virginia, Medicare pays $611.43 for 46040 in the office and $419.36 when it’s performed in a hospital or facility.

$611.43Office (non-facility)
$419.36Hospital or facility
−3.0%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 Virginia
  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 Virginia 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. Virginia pays $611.43. The RVUs are the same everywhere; the geographic indexes change the dollars.

46040 in Virginia vs other payment areas
  1. Virginia · this page$611.43
  2. Los Angeles, CA · California$699.96+$88.53
  3. Washington, DC area · District of Columbia$718.16+$106.73
  4. Miami, FL · Florida$708.58+$97.15
  5. Chicago, IL · Illinois$685.48+$74.05
  6. Manhattan, NY · New York$732.22+$120.79
  7. Alaska · Alaska$726.78+$115.35

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

Every other payment area

46040 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$654.71$440.56
Fresno, CACalifornia$654.51$440.36
Hanford, 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 Virginia 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

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 46040 in Virginia
ComponentRVULocality factorAdjusted
Physician work5.24× 1.0005.2400
Practice expense12.43× 0.98312.2187
Malpractice1.20× 0.7060.8472
Total RVUs18.3059
Conversion factor× 33.4009

Office rate, Virginia$611.43

Office: (5.24 × 1 + 12.43 × 0.983 + 1.2 × 0.706) × $33.4009 = $611.43

Facility: (5.24 × 1 + 6.58 × 0.983 + 1.2 × 0.706) × $33.4009 = $419.36

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, Virginia
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.$261.13
46060Abscess drainage, with fistula treatmentIncludes abscess drainage with fistulectomy or fistulotomy when fistula surgery is performed.No office rate

How 46040 has changed in Virginia

46040 · Office / nonfacility

$611.43

Effective 2026-10-01

The base rate is $79.87 higher than on 2025-10-01, moving from $531.56 to $611.43 (15.0%).

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

    $531.56changed to$611.43

    • 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 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $542.94changed to$531.56

    • 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

    $534.08changed to$542.94

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $556.13changed to$534.08

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 1.13 changed to 1.17
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $575.13changed to$556.13

    • 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
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $575.87changed to$575.13

    • 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

    $560.74changed to$575.87

    • 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
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $550.35changed to$560.74

    • 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
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $547.97changed to$550.35

    • 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

    $540.03changed to$547.97

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.84 changed to 8.96
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $536.38changed to$540.03

    • 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 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $539.14changed to$536.38

    • 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

    $536.46changed to$539.14

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $524.26changed to$536.46

    • 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
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $532.91changed to$524.26

    • 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
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $532.91

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$611.43$419.36RVU26D
2026-07-01$611.43$419.36RVU26C
2026-04-01$611.43$419.36RVU26B
2026-01-01$611.43$419.36RVU26A
2025-10-01$531.56$410.29RVU25D
2025-07-01$531.56$410.29RVU25C
2025-04-01$531.56$410.29RVU25B
2025-01-01$531.56$410.29RVU25A
2024-10-01$542.94$416.84RVU24D
2024-07-01$542.94$416.84RVU24C
2024-04-01$542.94$416.84RVU24B
2024-03-09$542.94$416.84RVU24AR
2024-01-01$534.08$410.03RVU24A
2023-10-01$556.13$424.29RVU23D
2023-07-01$556.13$424.29RVU23C
2023-04-01$556.13$424.29RVU23B
2023-01-01$556.13$424.29RVU23A
2022-10-01$575.13$435.33RVU22D
2022-07-01$575.13$435.33RVU22C
2022-04-01$575.13$435.33RVU22B
2022-01-01$575.13$435.33RVU22A
2021-10-01$575.87$432.83RVU21D
2021-07-01$575.87$432.83RVU21C
2021-04-01$575.87$432.83RVU21B
2021-01-01$575.87$432.83RVU21A
2020-10-01$560.74$433.06RVU20D
2020-07-01$560.74$433.06RVU20C
2020-04-01$560.74$433.06RVU20B
2020-01-01$560.74$433.06RVU20A
2019-10-01$550.35$427.40RVU19D
2019-07-01$550.35$427.40RVU19C
2019-04-01$550.35$427.40RVU19B
2019-01-01$550.35$427.40RVU19A
2018-10-01$547.97$425.15RVU18D
2018-07-01$547.97$425.15RVU18C
2018-04-01$547.97$425.15RVU18B
2018-01-01$547.97$425.15RVU18AR1
2017-10-01$540.03$420.19RVU17D
2017-07-01$540.03$420.19RVU17C
2017-04-01$540.03$420.19RVU17B
2017-01-01$540.03$420.19RVU17A
2016-10-01$536.38$417.42RVU16D
2016-07-01$536.38$417.42RVU16C
2016-04-01$536.38$417.42RVU16B
2016-01-01$536.38$417.42RVU16A
2015-10-01$539.14$418.34RVU15D
2015-07-01$539.14$418.34RVU15C
2015-04-01$536.46$416.26RVU15B
2015-01-01$536.46$416.26RVU15A
2014-10-01$524.26$408.76RVU14D
2014-07-01$524.26$408.76RVU14C
2014-04-01$524.26$408.76RVU14B
2014-01-01$524.26$408.76RVU14A
2013-10-01$532.91$408.59RVU13D
2013-07-01$532.91$408.59RVU13C
2013-04-01$532.91$408.59RVU13B
2013-01-01$532.91$408.59RVU13AR

Price 46040 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

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 VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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