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CPT code 46275: Fistula surgery, intersphincteric tract2026 Medicare rate & RVUs in Manhattan, NY

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 Manhattan, NY, Medicare pays $729.36 for 46275 in the office and $490.67 when it’s performed in a hospital or facility.

$729.36Office (non-facility)
$490.67Hospital or facility
+15.7%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 Manhattan, NY
  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 Manhattan, NY 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. Manhattan, NY pays $729.36. The RVUs are the same everywhere; the geographic indexes change the dollars.

46275 in Manhattan, NY vs other payment areas
  1. Manhattan, NY · this page$729.36
  2. NYC suburbs and Long Island, NY · New York$749.62+$20.26
  3. Poughkeepsie and northern NYC suburbs, NY · New York$685.46−$43.90
  4. Queens, NY · New York$733.08+$3.72
  5. Rest of New York · New York$599.81−$129.55
  6. Los Angeles, CA · California$703.98−$25.38
  7. Washington, DC area · District of Columbia$718.86−$10.50

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

Every other payment area

46275 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$697.94$484.10
Chicago, ILIllinois$676.34$469.90
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

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 Manhattan, NY 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

78

Locality
Manhattan, NY
Physician work
1.064
Practice expense
1.162
Malpractice
1.586
Office calculation for 46275 in Manhattan, NY
ComponentRVULocality factorAdjusted
Physician work5.28× 1.0645.6179
Practice expense12.62× 1.16214.6644
Malpractice0.98× 1.5861.5543
Total RVUs21.8366
Conversion factor× 33.4009

Office rate, Manhattan, NY$729.36

Office: (5.28 × 1.064 + 12.62 × 1.162 + 0.98 × 1.586) × $33.4009 = $729.36

Facility: (5.28 × 1.064 + 6.47 × 1.162 + 0.98 × 1.586) × $33.4009 = $490.67

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, Manhattan, NY
Same family
46270Anal fistula surgery, subcutaneous tractTreats a superficial subcutaneous fistula rather than an intersphincteric tract.$695.37
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.$729.89
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 Manhattan, NY

46275 · Office / nonfacility

$729.36

Effective 2026-10-01

The base rate is $88.73 higher than on 2025-10-01, moving from $640.63 to $729.36 (13.9%).

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

    $640.63changed to$729.36

    • 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
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.166 changed to 1.162
    • Malpractice GPCI 1.656 changed to 1.586

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $657.65changed to$640.63

    • 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

    $646.92changed to$657.65

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $679.63changed to$646.92

    • 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
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.184 changed to 1.166
    • Malpractice GPCI 1.843 changed to 1.656

  5. January 1, 2023

    RVU23A

    $709.75changed to$679.63

    • 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
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.203 changed to 1.184
    • Malpractice GPCI 2.031 changed to 1.843

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $707.21changed to$709.75

    • 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

    $676.67changed to$707.21

    • 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
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.192 changed to 1.203
    • Malpractice GPCI 1.823 changed to 2.031

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $655.20changed to$676.67

    • 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
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.180 changed to 1.192
    • Malpractice GPCI 1.615 changed to 1.823

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $650.24changed to$655.20

    • 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

    $643.88changed to$650.24

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.00 changed to 9.12
    • Practice expense GPCI 1.174 changed to 1.180
    • Malpractice GPCI 1.690 changed to 1.615

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $642.01changed to$643.88

    • 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 1.168 changed to 1.174
    • Malpractice GPCI 1.764 changed to 1.690

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $646.41changed to$642.01

    • 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

    $643.19changed to$646.41

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $626.10changed to$643.19

    • 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
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.165 changed to 1.168
    • Malpractice GPCI 1.518 changed to 1.764

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $630.80changed to$626.10

    • 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
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.162 changed to 1.165
    • Malpractice GPCI 1.271 changed to 1.518

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $630.80

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$729.36$490.67RVU26D
2026-07-01$729.36$490.67RVU26C
2026-04-01$729.36$490.67RVU26B
2026-01-01$729.36$490.67RVU26A
2025-10-01$640.63$484.11RVU25D
2025-07-01$640.63$484.11RVU25C
2025-04-01$640.63$484.11RVU25B
2025-01-01$640.63$484.11RVU25A
2024-10-01$657.65$493.86RVU24D
2024-07-01$657.65$493.86RVU24C
2024-04-01$657.65$493.86RVU24B
2024-03-09$657.65$493.86RVU24AR
2024-01-01$646.92$485.80RVU24A
2023-10-01$679.63$506.31RVU23D
2023-07-01$679.63$506.31RVU23C
2023-04-01$679.63$506.31RVU23B
2023-01-01$679.63$506.31RVU23A
2022-10-01$709.75$524.91RVU22D
2022-07-01$709.75$524.91RVU22C
2022-04-01$709.75$524.91RVU22B
2022-01-01$709.75$524.91RVU22A
2021-10-01$707.21$520.42RVU21D
2021-07-01$707.21$520.42RVU21C
2021-04-01$707.21$520.42RVU21B
2021-01-01$707.21$520.42RVU21A
2020-10-01$676.67$511.47RVU20D
2020-07-01$676.67$511.47RVU20C
2020-04-01$676.67$511.47RVU20B
2020-01-01$676.67$511.47RVU20A
2019-10-01$655.20$500.41RVU19D
2019-07-01$655.20$500.41RVU19C
2019-04-01$655.20$500.41RVU19B
2019-01-01$655.20$500.41RVU19A
2018-10-01$650.24$498.58RVU18D
2018-07-01$650.24$498.58RVU18C
2018-04-01$650.24$498.58RVU18B
2018-01-01$650.24$498.58RVU18AR1
2017-10-01$643.88$496.83RVU17D
2017-07-01$643.88$496.83RVU17C
2017-04-01$643.88$496.83RVU17B
2017-01-01$643.88$496.83RVU17A
2016-10-01$642.01$496.90RVU16D
2016-07-01$642.01$496.90RVU16C
2016-04-01$642.01$496.90RVU16B
2016-01-01$642.01$496.90RVU16A
2015-10-01$646.41$498.25RVU15D
2015-07-01$646.41$498.25RVU15C
2015-04-01$643.19$495.77RVU15B
2015-01-01$643.19$495.77RVU15A
2014-10-01$626.10$484.21RVU14D
2014-07-01$626.10$484.21RVU14C
2014-04-01$626.10$484.21RVU14B
2014-01-01$626.10$484.21RVU14A
2013-10-01$630.80$478.59RVU13D
2013-07-01$630.80$478.59RVU13C
2013-04-01$630.80$478.59RVU13B
2013-01-01$630.80$478.59RVU13AR

Price 46275 for an earlier date of service

Where the Manhattan, NY rate applies

Manhattan, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Manhattan, NYGPCI2026.csv, line 78 (RVU26D)

Open CMS sourceHow we calculate rates

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