FeeBase
Log inGet started
Menu

CPT code 46275: Fistula surgery, intersphincteric tract2026 Medicare rate & RVUs in Miami, FL

Report 46275 for operative treatment of an anal fistula that runs between the internal and external sphincters, based on documented tract anatomy.

CMS RVU26DEffective Oct 1, 2026One payment locality1K Medicare services in 2024

In Miami, FL, Medicare pays $697.94 for 46275 in the office and $484.10 when it’s performed in a hospital or facility.

$697.94Office (non-facility)
$484.10Hospital or facility
+10.7%vs the national office rate ($630.61)

Check a contract rate as a % of Medicare · 46275 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 46275 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Miami, FL
  2. What 46275 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 46275 covers

Code 46275 describes operative treatment of an anal fistula whose tract lies between the internal and external anal sphincters. The surgeon identifies the tract and opens or removes it as appropriate to the documented anatomy. Colorectal and general surgeons commonly perform this procedure in an operating room or ambulatory surgery setting. It is distinct from treatment of a superficial tract beneath the skin and from procedures for complex or staged fistulas.

Report this code when the operative findings and technique support an intersphincteric fistula; do not select it based on the external opening alone. The operative note should identify the tract course, sphincter involvement, treatment performed, and any associated procedure. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and remaining procedures at 50%. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is statutorily restricted, and 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 Miami, FL compares for 46275

Across 109 of 109 payment localities, the office rate for 46275 runs from $555.30 in Arkansas to $821.13 in San Benito County, CA. Miami, FL pays $697.94. The RVUs are the same everywhere; the geographic indexes change the dollars.

46275 in Miami, FL vs other payment areas
  1. Miami, FL · this page$697.94
  2. Fort Lauderdale, FL · Florida$662.54−$35.40
  3. Rest of Florida · Florida$628.53−$69.41
  4. Los Angeles, CA · California$703.98+$6.04
  5. Washington, DC area · District of Columbia$718.86+$20.92
  6. Chicago, IL · Illinois$676.34−$21.60
  7. Manhattan, NY · New York$729.36+$31.42

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

Every other payment area

46275 in every other Medicare payment locality
Payment localityOfficeFacility
AlaskaAlaska$731.49$512.72
AlabamaAlabama$563.71$383.97
ArkansasArkansas$555.30$378.85
ArizonaArizona$612.83$413.78
Bakersfield, CACalifornia$661.63$436.49
Chico, CACalifornia$658.88$433.75
El Centro, CACalifornia$659.05$433.91
Fresno, CACalifornia$658.88$433.75

46275 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.

$555.30

$740.01

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

View every state and territory as a table
46275 office rate range by state
State / territoryOffice rate rangeLocalities
AK$731.491
AL$563.711
AR$555.301
AZ$612.831
CA$658.88–$821.1329
CO$652.531
CT$673.471
DC$718.861
DE$623.131
FL$628.53–$697.943
GA$591.37–$644.462
GU$674.581
HI$674.581
IA$575.041
ID$579.641
IL$612.37–$676.344
IN$583.011
KS$573.911
KY$581.041
LA$580.76–$610.192
MA$649.13–$716.012
MD$634.75–$718.863
ME$584.51–$614.742
MI$598.16–$638.312
MN$619.791
MO$571.59–$610.443
MS$563.471
MT$630.541
NC$590.551
ND$611.171
NE$577.791
NH$643.801
NJ$679.62–$711.392
NM$602.201
NV$625.561
NY$599.81–$749.625
OH$594.201
OK$578.211
OR$619.20–$671.842
PA$594.24–$657.382
PR$634.751
RI$644.331
SC$593.661
SD$608.871
TN$577.101
TX$590.35–$651.688
UT$601.981
VA$613.82–$718.862
VI$634.751
VT$610.221
WA$647.42–$729.122
WI$590.251
WV$589.501
WY$622.101

See 46275 in every payment locality

How the 46275 rate is calculated

Each of 46275’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 · 46275

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.28

5.28 RVUs× 1.000 GPCI

Practice expense12.62

12.62 RVUs× 1.000 GPCI

Malpractice0.98

0.98 RVUs× 1.000 GPCI

Adjusted RVUs

18.8800

Conversion factor

$33.4009

Medicare rate

$630.61

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

The exact Miami, FL inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,591

Code
46275
Physician work
5.28
Practice expense
12.62
Malpractice
0.98

GPCI2026.csv

42

Locality
Miami, FL
Physician work
1.000
Practice expense
1.041
Malpractice
2.529
Office calculation for 46275 in Miami, FL
ComponentRVULocality factorAdjusted
Physician work5.28× 1.0005.2800
Practice expense12.62× 1.04113.1374
Malpractice0.98× 2.5292.4784
Total RVUs20.8958
Conversion factor× 33.4009

Office rate, Miami, FL$697.94

Office: (5.28 × 1 + 12.62 × 1.041 + 0.98 × 2.529) × $33.4009 = $697.94

Facility: (5.28 × 1 + 6.47 × 1.041 + 0.98 × 2.529) × $33.4009 = $484.10

Open 46275 in the RVU calculator

Payment rules and modifiers for 46275

46275 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46275

Fistula surgery, intersphincteric 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 · 46275

Fistula surgery, intersphincteric 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

46275 without 51 · national office

$630.61

Fistula surgery, intersphincteric tract

46275-51 · Second procedure: 50%

$315.31

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 46275

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

Codes related to 46275
CodeHow it relatesOffice range, Miami, FL
Same family
46270Anal fistula surgery, subcutaneous tractTreats a superficial subcutaneous fistula rather than an intersphincteric tract.$667.11
46280Anal fistula surgery, complex sphincter-crossing tractFor complex anal fistula anatomy rather than the intersphincteric level.No office rate
46285Anal fistula surgery, staged treatmentDescribes staged treatment of an anal fistula.$698.78
Used instead
46288Anal fistula repair, advancement flapDescribes fistula repair rather than the operative treatment represented by 46275.No office rate

How 46275 has changed in Miami, FL

46275 · Office / nonfacility

$697.94

Effective 2026-10-01

The base rate is $91.16 higher than on 2025-10-01, moving from $606.78 to $697.94 (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

    $606.78changed to$697.94

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.42 changed to 5.28
    • Practice expense RVU 10.70 changed to 12.62
    • Malpractice RVU 0.94 changed to 0.98
    • Practice expense GPCI 1.027 changed to 1.041
    • Malpractice GPCI 2.500 changed to 2.529

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $623.71changed to$606.78

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.63 changed to 10.70
    • Malpractice RVU 0.96 changed to 0.94

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $613.53changed to$623.71

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $633.53changed to$613.53

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.65 changed to 10.63
    • Malpractice RVU 0.92 changed to 0.96
    • Practice expense GPCI 1.025 changed to 1.027
    • Malpractice GPCI 2.564 changed to 2.500

  5. January 1, 2023

    RVU23A

    $652.65changed to$633.53

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.67 changed to 10.65
    • Malpractice RVU 0.96 changed to 0.92
    • Practice expense GPCI 1.023 changed to 1.025
    • Malpractice GPCI 2.629 changed to 2.564

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $649.95changed to$652.65

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.52 changed to 10.67
    • Malpractice RVU 0.93 changed to 0.96

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $634.74changed to$649.95

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.53 changed to 10.52
    • Malpractice RVU 0.92 changed to 0.93
    • Practice expense GPCI 1.026 changed to 1.023
    • Malpractice GPCI 2.598 changed to 2.629

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $628.80changed to$634.74

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.22 changed to 9.53
    • Malpractice RVU 0.99 changed to 0.92
    • Practice expense GPCI 1.029 changed to 1.026
    • Malpractice GPCI 2.566 changed to 2.598

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $624.41changed to$628.80

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.12 changed to 9.22

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $617.35changed to$624.41

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.00 changed to 9.12
    • Practice expense GPCI 1.031 changed to 1.029
    • Malpractice GPCI 2.528 changed to 2.566

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $614.61changed to$617.35

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.96 changed to 9.00
    • Malpractice RVU 1.00 changed to 0.99
    • Practice expense GPCI 1.033 changed to 1.031
    • Malpractice GPCI 2.490 changed to 2.528

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $617.33changed to$614.61

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.07 changed to 8.96
    • Malpractice RVU 0.96 changed to 1.00

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $614.26changed to$617.33

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $614.85changed to$614.26

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.86 changed to 9.07
    • Malpractice RVU 0.94 changed to 0.96
    • Practice expense GPCI 1.044 changed to 1.033
    • Malpractice GPCI 2.653 changed to 2.490

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $634.36changed to$614.85

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.93 changed to 8.86
    • Malpractice RVU 0.98 changed to 0.94
    • Practice expense GPCI 1.054 changed to 1.044
    • Malpractice GPCI 2.815 changed to 2.653

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $634.36

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$697.94$484.10RVU26D
2026-07-01$697.94$484.10RVU26C
2026-04-01$697.94$484.10RVU26B
2026-01-01$697.94$484.10RVU26A
2025-10-01$606.78$468.92RVU25D
2025-07-01$606.78$468.92RVU25C
2025-04-01$606.78$468.92RVU25B
2025-01-01$606.78$468.92RVU25A
2024-10-01$623.71$479.44RVU24D
2024-07-01$623.71$479.44RVU24C
2024-04-01$623.71$479.44RVU24B
2024-03-09$623.71$479.44RVU24AR
2024-01-01$613.53$471.62RVU24A
2023-10-01$633.53$483.47RVU23D
2023-07-01$633.53$483.47RVU23C
2023-04-01$633.53$483.47RVU23B
2023-01-01$633.53$483.47RVU23A
2022-10-01$652.65$495.46RVU22D
2022-07-01$652.65$495.46RVU22C
2022-04-01$652.65$495.46RVU22B
2022-01-01$652.65$495.46RVU22A
2021-10-01$649.95$491.11RVU21D
2021-07-01$649.95$491.11RVU21C
2021-04-01$649.95$491.11RVU21B
2021-01-01$649.95$491.11RVU21A
2020-10-01$634.74$492.55RVU20D
2020-07-01$634.74$492.55RVU20C
2020-04-01$634.74$492.55RVU20B
2020-01-01$634.74$492.55RVU20A
2019-10-01$628.80$493.81RVU19D
2019-07-01$628.80$493.81RVU19C
2019-04-01$628.80$493.81RVU19B
2019-01-01$628.80$493.81RVU19A
2018-10-01$624.41$492.16RVU18D
2018-07-01$624.41$492.16RVU18C
2018-04-01$624.41$492.16RVU18B
2018-01-01$624.41$492.16RVU18AR1
2017-10-01$617.35$488.21RVU17D
2017-07-01$617.35$488.21RVU17C
2017-04-01$617.35$488.21RVU17B
2017-01-01$617.35$488.21RVU17A
2016-10-01$614.61$486.26RVU16D
2016-07-01$614.61$486.26RVU16C
2016-04-01$614.61$486.26RVU16B
2016-01-01$614.61$486.26RVU16A
2015-10-01$617.33$486.30RVU15D
2015-07-01$617.33$486.30RVU15C
2015-04-01$614.26$483.88RVU15B
2015-01-01$614.26$483.88RVU15A
2014-10-01$614.85$487.69RVU14D
2014-07-01$614.85$487.69RVU14C
2014-04-01$614.85$487.69RVU14B
2014-01-01$614.85$487.69RVU14A
2013-10-01$634.36$496.29RVU13D
2013-07-01$634.36$496.29RVU13C
2013-04-01$634.36$496.29RVU13B
2013-01-01$634.36$496.29RVU13AR

Price 46275 for an earlier date of service

Where the Miami, FL rate applies

Miami, FL is a Medicare payment area, not a city. Our Census mapping connects it to 83 cities and communities in Florida. Some span more than one payment area; confirm with the service ZIP.

  • Miami
  • Aventura
  • Bal Harbour
  • Bay Harbor Islands
  • Big Coppitt Key
  • Big Pine Key
  • Biscayne Gardens
  • Biscayne Park

Browse all communities in Florida

46275 billing questions

How is 46275 distinguished from 46270?

46275 is for an intersphincteric tract between the anal sphincters. Code 46270 is for a subcutaneous tract, so document the tract’s course and sphincter relationship.

What documentation supports reporting 46275?

The operative report should describe the fistula’s course, its relationship to the sphincters, and the treatment performed. The external opening alone does not establish the intersphincteric anatomy.

Can 46275 be reported with hemorrhoid excision?

When the surgeon also excises an internal or external hemorrhoid group and treats the fistula, compare the combined service with 46258. Other procedures performed in the same session are subject to the standard multiple-procedure payment reduction.

Can modifier 50 be used for 46275?

No. The anatomy is not appropriate for bilateral modifier 50 reporting.

How does the global period affect follow-up visits?

The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.

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 46275PPRRVU2026_Oct_nonQPP.csv, line 5,591 (RVU26D)
Geographic factors for Miami, FLGPCI2026.csv, line 42 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 46275 pays in Miami, FL?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 46275 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist