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CPT code 46270: Anal fistula surgery, subcutaneous tract2026 Medicare rate & RVUs in Puerto Rico

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 Puerto Rico, Medicare pays $603.86 for 46270 in the office and $410.03 when it’s performed in a hospital or facility.

$603.86Office (non-facility)
$410.03Hospital or facility
+0.7%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $603.86. The RVUs are the same everywhere; the geographic indexes change the dollars.

46270 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$603.86
  2. Los Angeles, CA · California$669.73+$65.87
  3. Washington, DC area · District of Columbia$684.63+$80.77
  4. Miami, FL · Florida$667.11+$63.25
  5. Chicago, IL · Illinois$645.86+$42.00
  6. Manhattan, NY · New York$695.37+$91.51
  7. Alaska · Alaska$691.62+$87.76

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

Every other payment area

46270 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$534.72$366.96
ArkansasArkansas$526.53$361.84
ArizonaArizona$582.52$396.74
Bakersfield, CACalifornia$629.02$418.89
Chico, CACalifornia$626.29$416.16
El Centro, CACalifornia$626.45$416.32
Fresno, CACalifornia$626.29$416.16
Hanford, CACalifornia$626.29$416.16

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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 46270 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work4.80× 1.0004.8000
Practice expense12.17× 1.01112.3039
Malpractice0.99× 0.9850.9751
Total RVUs18.0790
Conversion factor× 33.4009

Office rate, Puerto Rico$603.86

Office: (4.8 × 1 + 12.17 × 1.011 + 0.99 × 0.985) × $33.4009 = $603.86

Facility: (4.8 × 1 + 6.43 × 1.011 + 0.99 × 0.985) × $33.4009 = $410.03

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, Puerto Rico
Same family
46275Fistula surgery, intersphincteric tractSibling code for surgical treatment of an intersphincteric anal fistula.$634.75
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.$635.08
Used instead
46288Anal fistula repair, advancement flapAnal fistula repair rather than subcutaneous fistula surgery.No office rate

How 46270 has changed in Puerto Rico

46270 · Office / nonfacility

$603.86

Effective 2026-10-01

The base rate is $78.40 higher than on 2025-10-01, moving from $525.46 to $603.86 (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

    $525.46changed to$603.86

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $537.72changed to$525.46

    • 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

    $528.94changed to$537.72

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $548.53changed to$528.94

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $546.26changed to$548.53

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $562.66changed to$546.26

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $562.42changed to$562.66

    • 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.

  8. January 1, 2021

    RVU21A

    $545.75changed to$562.42

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $535.62changed to$545.75

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $528.51changed to$535.62

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $464.35changed to$528.51

    • 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
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $404.04changed to$464.35

    • 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
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $406.45changed to$404.04

    • 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.

  14. July 1, 2015

    RVU15C

    $404.43changed to$406.45

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $395.09changed to$404.43

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $393.68changed to$395.09

    • 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
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $393.68

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$603.86$410.03RVU26D
2026-07-01$603.86$410.03RVU26C
2026-04-01$603.86$410.03RVU26B
2026-01-01$603.86$410.03RVU26A
2025-10-01$525.46$398.75RVU25D
2025-07-01$525.46$398.75RVU25C
2025-04-01$525.46$398.75RVU25B
2025-01-01$525.46$398.75RVU25A
2024-10-01$537.72$405.31RVU24D
2024-07-01$537.72$405.31RVU24C
2024-04-01$537.72$405.31RVU24B
2024-03-09$537.72$405.31RVU24AR
2024-01-01$528.94$398.70RVU24A
2023-10-01$548.53$409.50RVU23D
2023-07-01$546.26$408.34RVU23C
2023-04-01$546.26$408.34RVU23B
2023-01-01$546.26$408.34RVU23A
2022-10-01$562.66$415.46RVU22D
2022-07-01$562.66$415.46RVU22C
2022-04-01$562.66$415.46RVU22B
2022-01-01$562.66$415.46RVU22A
2021-10-01$562.42$413.29RVU21D
2021-07-01$562.42$413.29RVU21C
2021-04-01$562.42$413.29RVU21B
2021-01-01$562.42$413.29RVU21A
2020-10-01$545.75$413.70RVU20D
2020-07-01$545.75$413.70RVU20C
2020-04-01$545.75$413.70RVU20B
2020-01-01$545.75$413.70RVU20A
2019-10-01$535.62$410.78RVU19D
2019-07-01$535.62$410.78RVU19C
2019-04-01$535.62$410.78RVU19B
2019-01-01$535.62$410.78RVU19A
2018-10-01$528.51$408.15RVU18D
2018-07-01$528.51$408.15RVU18C
2018-04-01$528.51$408.15RVU18B
2018-01-01$528.51$408.15RVU18AR1
2017-10-01$464.35$364.20RVU17D
2017-07-01$464.35$364.20RVU17C
2017-04-01$464.35$364.20RVU17B
2017-01-01$464.35$364.20RVU17A
2016-10-01$404.04$322.01RVU16D
2016-07-01$404.04$322.01RVU16C
2016-04-01$404.04$322.01RVU16B
2016-01-01$404.04$322.01RVU16A
2015-10-01$406.45$323.11RVU15D
2015-07-01$406.45$323.11RVU15C
2015-04-01$404.43$321.50RVU15B
2015-01-01$404.43$321.50RVU15A
2014-10-01$395.09$316.26RVU14D
2014-07-01$395.09$316.26RVU14C
2014-04-01$395.09$316.26RVU14B
2014-01-01$395.09$316.26RVU14A
2013-10-01$393.68$311.33RVU13D
2013-07-01$393.68$311.33RVU13C
2013-04-01$393.68$311.33RVU13B
2013-01-01$393.68$311.33RVU13AR

Price 46270 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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