CPT code 46275: Fistula surgery, intersphincteric tract2026 Medicare rate & RVUs in Missouri
Report 46275 for operative treatment of an anal fistula that runs between the internal and external sphincters, based on documented tract anatomy.
Medicare pays $571.59–$610.44 for 46275 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
Where 46275 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$571.59 to $610.44
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $604.14 | $411.26 |
| Metropolitan St. Louis, MO | $610.44 | $414.89 |
| Rest of Missouri | $571.59 | $394.52 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share 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.
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%).
46275 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46270Anal fistula surgerySubcutaneous tract
- Use 46270 for a subcutaneous fistula tract beneath the skin. Use 46275 when the tract runs between the internal and external sphincters.
- 46280Anal fistula surgeryComplex sphincter-crossing tract
- 46280 is for complex fistula anatomy; 46275 is for an intersphincteric tract. Base the choice on the operative findings and tract course.
- 46285Anal fistula surgeryStaged treatment
- 46285 represents a two-stage fistula treatment approach. Choose 46275 for treatment of an intersphincteric tract when the documented procedure is not staged.
- 46258HemorrhoidectomySingle group with fistulectomy
- 46258 describes excision of an internal or external hemorrhoid group with fistula treatment. Compare it when both services are performed together rather than reporting only the fistula service.
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
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