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CPT code 46270: Anal fistula surgery, subcutaneous tract2026 Medicare rate & RVUs in Santa Clara County, CA

Reports surgical treatment of a superficial anal fistula confined to the subcutaneous tissue, without a deeper tract involving the sphincter muscles.

CMS RVU26DEffective Oct 1, 2026One payment locality1.5K Medicare services in 2024

In Santa Clara County, CA, Medicare pays $777.24 for 46270 in the office and $500.78 when it’s performed in a hospital or facility.

$777.24Office (non-facility)
$500.78Hospital or facility
+29.6%vs the national office rate ($599.88)

Check a contract rate as a % of Medicare · 46270 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 46270 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 46270 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 46270 covers

This service treats a superficial anal fistula whose tract is confined to tissue beneath the skin around the anus. The surgeon opens or excises the tract to treat the fistula. Colorectal and general surgeons typically perform the procedure in an operating room or ambulatory surgery setting. The operative note should establish the tract’s course and its relationship to the sphincter muscles.

Select this code by the documented anatomy and extent of the fistula, not simply by the fact that a fistula was treated. A tract involving the sphincter or a complex course points to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. Modifier 50 is inappropriate for this service. 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 Santa Clara County, CA compares for 46270

Across 109 of 109 payment localities, the office rate for 46270 runs from $526.53 in Arkansas to $781.84 in San Benito County, CA. Santa Clara County, CA pays $777.24. The RVUs are the same everywhere; the geographic indexes change the dollars.

46270 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$777.24
  2. Bakersfield, CA · California$629.02−$148.22
  3. Chico, CA · California$626.29−$150.95
  4. El Centro, CA · California$626.45−$150.79
  5. Fresno, CA · California$626.29−$150.95
  6. Hanford, CA · California$626.29−$150.95
  7. Los Angeles, CA · California$669.73−$107.51

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

Every other payment area

46270 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$626.29$416.16
Merced, CACalifornia$626.29$416.16
Modesto, CACalifornia$626.29$416.16
Napa, CACalifornia$722.98$470.29
Oxnard, CACalifornia$665.88$439.27
Redding, CACalifornia$626.29$416.16
Rest of CaliforniaCalifornia$626.29$416.16
Riverside, CACalifornia$636.93$426.80

46270 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.

$526.53

$704.07

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

View every state and territory as a table
46270 office rate range by state
State / territoryOffice rate rangeLocalities
AK$691.621
AL$534.721
AR$526.531
AZ$582.521
CA$626.29–$781.8429
CO$620.581
CT$641.331
DC$684.631
DE$592.461
FL$598.63–$667.113
GA$562.33–$613.512
GU$641.651
HI$641.651
IA$545.391
ID$549.931
IL$583.13–$645.864
IN$553.211
KS$544.461
KY$551.951
LA$551.75–$580.392
MA$617.28–$681.672
MD$603.65–$684.633
ME$554.86–$584.022
MI$568.78–$608.342
MN$588.391
MO$542.92–$580.433
MS$534.751
MT$599.811
NC$560.711
ND$580.241
NE$548.011
NH$612.411
NJ$646.90–$677.272
NM$572.791
NV$594.761
NY$569.73–$715.315
OH$564.781
OK$549.011
OR$588.43–$639.102
PA$564.73–$625.812
PR$603.861
RI$612.771
SC$564.031
SD$577.921
TN$547.581
TX$560.95–$620.018
UT$572.121
VA$583.25–$684.632
VI$603.861
VT$579.481
WA$615.61–$694.122
WI$559.931
WV$560.881
WY$591.281

See 46270 in every payment locality

How the 46270 rate is calculated

Each of 46270’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 · 46270

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.80

4.80 RVUs× 1.000 GPCI

Practice expense12.17

12.17 RVUs× 1.000 GPCI

Malpractice0.99

0.99 RVUs× 1.000 GPCI

Adjusted RVUs

17.9600

Conversion factor

$33.4009

Medicare rate

$599.88

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

The exact Santa Clara County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,590

Code
46270
Physician work
4.80
Practice expense
12.17
Malpractice
0.99

GPCI2026.csv

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 46270 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work4.80× 1.1105.3280
Practice expense12.17× 1.44217.5491
Malpractice0.99× 0.3970.3930
Total RVUs23.2702
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$777.24

Office: (4.8 × 1.11 + 12.17 × 1.442 + 0.99 × 0.397) × $33.4009 = $777.24

Facility: (4.8 × 1.11 + 6.43 × 1.442 + 0.99 × 0.397) × $33.4009 = $500.78

Open 46270 in the RVU calculator

Payment rules and modifiers for 46270

46270 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46270

Anal fistula surgery, subcutaneous tract

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 · 46270

Anal fistula surgery, subcutaneous tract

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

46270 without 51 · national office

$599.88

Anal fistula surgery, subcutaneous tract

46270-51 · Second procedure: 50%

$299.94

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 46270

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

Codes related to 46270
CodeHow it relatesOffice range, Santa Clara County, CA
Same family
46275Fistula surgery, intersphincteric tractSibling code for surgical treatment of an intersphincteric anal fistula.$816.58
46280Anal fistula surgery, complex sphincter-crossing tractSibling code for surgical treatment of a complex anal fistula.No office rate
46285Anal fistula surgery, staged treatmentSibling code for staged surgical treatment of an anal fistula.$816.71
Used instead
46288Anal fistula repair, advancement flapAnal fistula repair rather than subcutaneous fistula surgery.No office rate

How 46270 has changed in Santa Clara County, CA

46270 · Office / nonfacility

$777.24

Effective 2026-10-01

The base rate is $110.91 higher than on 2025-10-01, moving from $666.33 to $777.24 (16.6%).

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

    $666.33changed to$777.24

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.92 changed to 4.80
    • Practice expense RVU 10.30 changed to 12.17
    • Malpractice RVU 0.97 changed to 0.99
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $681.08changed to$666.33

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.20 changed to 10.30
    • Malpractice RVU 0.98 changed to 0.97

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $669.97changed to$681.08

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $685.90changed to$669.97

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.25 changed to 10.20
    • Malpractice RVU 0.95 changed to 0.98
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $693.80changed to$685.90

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.31 changed to 10.25
    • Malpractice RVU 0.96 changed to 0.95
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $693.47changed to$693.80

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.19 changed to 10.31
    • Malpractice RVU 0.94 changed to 0.96

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $661.16changed to$693.47

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.19 changed to 10.19
    • Malpractice RVU 0.95 changed to 0.94
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $639.82changed to$661.16

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.89 changed to 9.19
    • Malpractice RVU 1.00 changed to 0.95
    • Work GPCI 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $630.34changed to$639.82

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.71 changed to 8.89

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $623.79changed to$630.34

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.61 changed to 8.71
    • Malpractice RVU 1.01 changed to 1.00
    • Work GPCI 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $621.76changed to$623.79

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.60 changed to 8.61
    • Malpractice RVU 1.03 changed to 1.01
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $625.98changed to$621.76

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.65 changed to 8.60
    • Malpractice RVU 1.00 changed to 1.03

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $622.87changed to$625.98

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $613.28changed to$622.87

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.46 changed to 8.65
    • Malpractice RVU 0.94 changed to 1.00
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $627.36changed to$613.28

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.45 changed to 8.46
    • Malpractice RVU 0.98 changed to 0.94
    • Work GPCI 1.077 changed to 1.083
    • Practice expense GPCI 1.337 changed to 1.342
    • Malpractice GPCI 0.516 changed to 0.466

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$627.36

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$777.24$500.78RVU26D
2026-07-01$777.24$500.78RVU26C
2026-04-01$777.24$500.78RVU26B
2026-01-01$777.24$500.78RVU26A
2025-10-01$666.33$485.77RVU25D
2025-07-01$666.33$485.77RVU25C
2025-04-01$666.33$485.77RVU25B
2025-01-01$666.33$485.77RVU25A
2024-10-01$681.08$492.40RVU24D
2024-07-01$681.08$492.40RVU24C
2024-04-01$681.08$492.40RVU24B
2024-03-09$681.08$492.40RVU24AR
2024-01-01$669.97$484.36RVU24A
2023-10-01$685.90$491.57RVU23D
2023-07-01$685.90$491.57RVU23C
2023-04-01$685.90$491.57RVU23B
2023-01-01$685.90$491.57RVU23A
2022-10-01$693.80$491.83RVU22D
2022-07-01$693.80$491.83RVU22C
2022-04-01$693.80$491.83RVU22B
2022-01-01$693.80$491.83RVU22A
2021-10-01$693.47$488.86RVU21D
2021-07-01$693.47$488.86RVU21C
2021-04-01$693.47$488.86RVU21B
2021-01-01$693.47$488.86RVU21A
2020-10-01$661.16$481.81RVU20D
2020-07-01$661.16$481.81RVU20C
2020-04-01$661.16$481.81RVU20B
2020-01-01$661.16$481.81RVU20A
2019-10-01$639.82$471.96RVU19D
2019-07-01$639.82$471.96RVU19C
2019-04-01$639.82$471.96RVU19B
2019-01-01$639.82$471.96RVU19A
2018-10-01$630.34$468.51RVU18D
2018-07-01$630.34$468.51RVU18C
2018-04-01$630.34$468.51RVU18B
2018-01-01$630.34$468.51RVU18AR1
2017-10-01$623.79$465.73RVU17D
2017-07-01$623.79$465.73RVU17C
2017-04-01$623.79$465.73RVU17B
2017-01-01$623.79$465.73RVU17A
2016-10-01$621.76$465.02RVU16D
2016-07-01$621.76$465.02RVU16C
2016-04-01$621.76$465.02RVU16B
2016-01-01$621.76$465.02RVU16A
2015-10-01$625.98$466.74RVU15D
2015-07-01$625.98$466.74RVU15C
2015-04-01$622.87$464.41RVU15B
2015-01-01$622.87$464.41RVU15A
2014-10-01$613.28$460.40RVU14D
2014-07-01$613.28$460.40RVU14C
2014-04-01$613.28$460.40RVU14B
2014-01-01$613.28$460.40RVU14A
2013-10-01$627.36$464.96RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46270 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

46270 billing questions

How does 46270 differ from 46275?

46270 is for a fistula confined to subcutaneous tissue. Use 46275 when the documented tract is intersphincteric.

When is 46280 a better fit?

46280 describes treatment of a complex anal fistula. Choose based on the documented tract anatomy and complexity rather than the procedure name alone.

Can 46270 be reported with modifier 50?

No. The anatomy and service do not support bilateral adjustment, so modifier 50 is inappropriate.

What documentation supports 46270?

Document the fistula tract’s course, its depth and relationship to the sphincter muscles, and the surgical treatment performed.

Are related postoperative visits separately reported?

Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.

Can an assistant surgeon or co-surgeon be paid for 46270?

Medicare does not pay an assistant at surgery for this service. 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 46270PPRRVU2026_Oct_nonQPP.csv, line 5,590 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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