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

Reports operative removal of diseased anal fissure tissue, including sphincterotomy when performed, when the fissure is treated surgically.

CMS RVU26DEffective Oct 1, 2026One payment locality818 Medicare services in 2024

In Iowa, Medicare pays $485.18 for 46200 in the office and $317.70 when it’s performed in a hospital or facility.

$485.18Office (non-facility)
$317.70Hospital or facility
−8.6%vs the national office rate ($530.74)

Check a contract rate as a % of Medicare · 46200 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 46200 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 46200 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 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.

How Iowa compares for 46200

Across 109 of 109 payment localities, the office rate for 46200 runs from $465.50 in Arkansas to $708.36 in San Benito County, CA. Iowa pays $485.18. The RVUs are the same everywhere; the geographic indexes change the dollars.

46200 in Iowa vs other payment areas
  1. Iowa · this page$485.18
  2. Los Angeles, CA · California$600.86+$115.68
  3. Washington, DC area · District of Columbia$609.41+$124.23
  4. Miami, FL · Florida$577.53+$92.35
  5. Chicago, IL · Illinois$559.48+$74.30
  6. Manhattan, NY · New York$613.76+$128.58
  7. Alaska · Alaska$605.79+$120.61

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

Every other payment area

46200 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$472.82$312.66
ArkansasArkansas$465.50$308.27
ArizonaArizona$515.65$338.28
Bakersfield, CACalifornia$562.93$362.32
Chico, CACalifornia$561.23$360.62
El Centro, CACalifornia$561.33$360.73
Fresno, CACalifornia$561.23$360.62
Hanford, CACalifornia$561.23$360.62

46200 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.

$465.50

$634.80

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

View every state and territory as a table
46200 office rate range by state
State / territoryOffice rate rangeLocalities
AK$605.791
AL$472.821
AR$465.501
AZ$515.651
CA$561.23–$708.3629
CO$552.961
CT$567.611
DC$609.411
DE$524.581
FL$523.49–$577.533
GA$492.06–$541.422
GU$576.251
HI$576.251
IA$485.181
ID$488.681
IL$507.76–$559.484
IN$491.691
KS$483.001
KY$485.331
LA$484.61–$510.232
MA$549.41–$609.732
MD$534.99–$609.413
ME$491.66–$519.802
MI$499.07–$530.712
MN$528.051
MO$475.88–$511.883
MS$470.771
MT$530.701
NC$497.121
ND$518.841
NE$487.951
NH$544.381
NJ$573.59–$602.482
NM$502.081
NV$527.791
NY$505.10–$629.825
OH$496.641
OK$484.141
OR$523.21–$571.192
PA$497.35–$552.862
PR$534.771
RI$543.791
SC$497.811
SD$517.431
TN$485.631
TX$493.88–$551.538
UT$505.071
VA$518.15–$609.412
VI$534.771
VT$516.901
WA$548.34–$622.312
WI$500.331
WV$487.791
WY$525.531

See 46200 in every payment locality

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.

How the rate is built · 46200

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.50

3.50 RVUs× 1.000 GPCI

Practice expense11.79

11.79 RVUs× 1.000 GPCI

Malpractice0.60

0.60 RVUs× 1.000 GPCI

Adjusted RVUs

15.8900

Conversion factor

$33.4009

Medicare rate

$530.74

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

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,579

Code
46200
Physician work
3.50
Practice expense
11.79
Malpractice
0.60

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 46200 in Iowa
ComponentRVULocality factorAdjusted
Physician work3.50× 1.0003.5000
Practice expense11.79× 0.91510.7878
Malpractice0.60× 0.3970.2382
Total RVUs14.5260
Conversion factor× 33.4009

Office rate, Iowa$485.18

Office: (3.5 × 1 + 11.79 × 0.915 + 0.6 × 0.397) × $33.4009 = $485.18

Facility: (3.5 × 1 + 6.31 × 0.915 + 0.6 × 0.397) × $33.4009 = $317.70

Open 46200 in the RVU calculator

Payment rules and modifiers for 46200

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

CMS payment indicators · 46200

Fissure surgery, fissure excision

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 · 46200

Fissure surgery, fissure excision

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

46200 without 51 · national office

$530.74

Fissure surgery, fissure excision

46200-51 · Second procedure: 50%

$265.37

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 46200

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

Codes related to 46200
CodeHow it relatesOffice range, Iowa
Used instead
46257Hemorrhoidectomy, one group with fissurectomyCombines fissure treatment with hemorrhoidectomy for one internal or external hemorrhoid group.No office rate
46261Hemorrhoidectomy, multiple groups with fissurectomyCombines fissure treatment with hemorrhoidectomy for two or more hemorrhoid groups.No office rate
Same family
46220Anal tag excision, single external tagNearby anorectal excision code for an anal papilla rather than the fissure itself.$251.57
46230Anal tag excision, multiple tagsRemoves anal tags; the target is tag tissue, not the anal fissure.$312.19

How 46200 has changed in Iowa

46200 · Office / nonfacility

$485.18

Effective 2026-10-01

The base rate is $60.14 higher than on 2025-10-01, moving from $425.04 to $485.18 (14.1%).

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

    $425.04changed to$485.18

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.59 changed to 3.50
    • Practice expense RVU 10.16 changed to 11.79
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $436.65changed to$425.04

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.13 changed to 10.16
    • Malpractice RVU 0.61 changed to 0.60

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $429.52changed to$436.65

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $443.00changed to$429.52

    • Conversion factor 33.8872 changed to 32.7442
    • Malpractice RVU 0.60 changed to 0.61
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $451.31changed to$443.00

    • Conversion factor 34.6062 changed to 33.8872
    • Malpractice RVU 0.62 changed to 0.60
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $452.52changed to$451.31

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.05 changed to 10.13

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $434.96changed to$452.52

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.04 changed to 10.05
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $425.46changed to$434.96

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.75 changed to 9.04
    • Malpractice RVU 0.66 changed to 0.62
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $420.42changed to$425.46

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.61 changed to 8.75

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $415.01changed to$420.42

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.50 changed to 8.61
    • Malpractice RVU 0.67 changed to 0.66
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $411.45changed to$415.01

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.45 changed to 8.50
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $415.65changed to$411.45

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.54 changed to 8.45
    • Malpractice RVU 0.66 changed to 0.67

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $413.58changed to$415.65

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $404.67changed to$413.58

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.32 changed to 8.54
    • Malpractice RVU 0.60 changed to 0.66
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $414.39changed to$404.67

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.36 changed to 8.32
    • Malpractice RVU 0.63 changed to 0.60
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $414.39

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$485.18$317.70RVU26D
2026-07-01$485.18$317.70RVU26C
2026-04-01$485.18$317.70RVU26B
2026-01-01$485.18$317.70RVU26A
2025-10-01$425.04$307.21RVU25D
2025-07-01$425.04$307.21RVU25C
2025-04-01$425.04$307.21RVU25B
2025-01-01$425.04$307.21RVU25A
2024-10-01$436.65$312.95RVU24D
2024-07-01$436.65$312.95RVU24C
2024-04-01$436.65$312.95RVU24B
2024-03-09$436.65$312.95RVU24AR
2024-01-01$429.52$307.85RVU24A
2023-10-01$443.00$314.41RVU23D
2023-07-01$443.00$314.41RVU23C
2023-04-01$443.00$314.41RVU23B
2023-01-01$443.00$314.41RVU23A
2022-10-01$451.31$316.97RVU22D
2022-07-01$451.31$316.97RVU22C
2022-04-01$451.31$316.97RVU22B
2022-01-01$451.31$316.97RVU22A
2021-10-01$452.52$315.49RVU21D
2021-07-01$452.52$315.49RVU21C
2021-04-01$452.52$315.49RVU21B
2021-01-01$452.52$315.49RVU21A
2020-10-01$434.96$313.52RVU20D
2020-07-01$434.96$313.52RVU20C
2020-04-01$434.96$313.52RVU20B
2020-01-01$434.96$313.52RVU20A
2019-10-01$425.46$309.42RVU19D
2019-07-01$425.46$309.42RVU19C
2019-04-01$425.46$309.42RVU19B
2019-01-01$425.46$309.42RVU19A
2018-10-01$420.42$307.77RVU18D
2018-07-01$420.42$307.77RVU18C
2018-04-01$420.42$307.77RVU18B
2018-01-01$420.42$307.77RVU18AR1
2017-10-01$415.01$305.60RVU17D
2017-07-01$415.01$305.60RVU17C
2017-04-01$415.01$305.60RVU17B
2017-01-01$415.01$305.60RVU17A
2016-10-01$411.45$303.98RVU16D
2016-07-01$411.45$303.98RVU16C
2016-04-01$411.45$303.98RVU16B
2016-01-01$411.45$303.98RVU16A
2015-10-01$415.65$305.54RVU15D
2015-07-01$415.65$305.54RVU15C
2015-04-01$413.58$304.02RVU15B
2015-01-01$413.58$304.02RVU15A
2014-10-01$404.67$299.86RVU14D
2014-07-01$404.67$299.86RVU14C
2014-04-01$404.67$299.86RVU14B
2014-01-01$404.67$299.86RVU14A
2013-10-01$414.39$302.12RVU13D
2013-07-01$414.39$302.12RVU13C
2013-04-01$414.39$302.12RVU13B
2013-01-01$414.39$302.12RVU13AR

Price 46200 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

46200 billing questions

When should 46200 be reported instead of 46257 or 46261?

Report 46200 when the operation excises the fissure without the qualifying hemorrhoidectomy described by a combined code. Codes 46257 and 46261 combine fissure treatment with hemorrhoidectomy for the specified hemorrhoid groups.

Is sphincterotomy separately reported with 46200?

Sphincterotomy performed as part of the fissure operation is included in 46200. The operative report should document the work performed.

Does modifier 50 apply to 46200?

No. The anal anatomy and service are not reported bilaterally, so modifier 50 is inappropriate.

How does the 90-day global period affect postoperative visits?

The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are not separately reported as routine postoperative visits.

What happens when another procedure is performed in the same session?

Medicare pays the highest-valued procedure in full and reduces the other procedure or procedures to 50%. An assistant at surgery is not paid, and co-surgeons and team surgery are not permitted.

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 46200PPRRVU2026_Oct_nonQPP.csv, line 5,579 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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