CPT code 46200: Fissure surgery, fissure excision2026 Medicare rate & RVUs

Medicare pays $530.74 for 46200 nationally in the office and $347.70 in a hospital or facility. Local office rates run $465.50–$708.36.

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

What 46200 covers

The surgeon removes diseased tissue from an anal fissure; sphincterotomy is included when performed as part of the operation. Colorectal and general surgeons typically perform this procedure in an operating room under anesthesia for a fissure requiring surgical treatment. The operative report should identify the fissure and describe the excision and any sphincter work performed.

Select this code when the fissure itself is excised. When hemorrhoidectomy and fissure treatment are performed together, consider the combined hemorrhoidectomy-and-fissure codes 46257 or 46261 according to the hemorrhoid groups treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces other procedures to 50%. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery; co-surgeons and team surgery 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.

Where 46200 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

46200 rates by state

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

How the 46200 rate is calculated

Each of 46200’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.

Payment rules and modifiers for 46200

46200 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

46200 compared with similar codes

How to choose

46257HemorrhoidectomyOne group with fissurectomy

Use this combined code when fissure treatment accompanies hemorrhoidectomy for one internal or external hemorrhoid group; 46200 describes fissure excision without that combined service.

46261HemorrhoidectomyMultiple groups with fissurectomy

This combined code describes fissure treatment with hemorrhoidectomy for two or more groups. Choose 46200 when the operative service is fissure excision without that hemorrhoidectomy.

46220Anal tag excisionSingle external tag

This code targets an anal papilla, not the fissure. Choose 46200 when the surgeon excises diseased fissure tissue.

46230Anal tag excisionMultiple tags

This code targets anal tags. It is not a substitute for fissure excision when the operative target is the fissure.

Codes related to 46200

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

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

Open CMS sourceHow we calculate rates