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CPT code 46285: Anal fistula surgery, staged treatment2026 Medicare rate & RVUs in Puerto Rico

Report staged surgical treatment of an anal fistula with seton placement when the operative plan treats the tract in separate stages rather than definitively at one operation.

CMS RVU26DEffective Oct 1, 2026One payment locality183 Medicare services in 2024

In Puerto Rico, Medicare pays $635.08 for 46285 in the office and $428.76 when it’s performed in a hospital or facility.

$635.08Office (non-facility)
$428.76Hospital or facility
+0.7%vs the national office rate ($630.94)

Check a contract rate as a % of Medicare · 46285 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 46285 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 46285 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 46285 covers

A colorectal or general surgeon uses this code for an operative plan that treats an anal fistula in stages, including placement of a seton to maintain drainage between procedures. Staged management may be selected when immediate division of the tract could threaten sphincter function. The procedure is generally performed in an operating room, with the operative report documenting the fistula tract, seton placement, and staged treatment plan.

Report this code for the staged seton procedure, not for a single-stage operation selected by fistula anatomy or for a repair coded by its method. The record should support that treatment is staged and describe the work performed during the encounter. CMS classifies the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing 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 46285

Across 109 of 109 payment localities, the office rate for 46285 runs from $555.47 in Arkansas to $821.31 in San Benito County, CA. Puerto Rico pays $635.08. The RVUs are the same everywhere; the geographic indexes change the dollars.

46285 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$635.08
  2. Los Angeles, CA · California$704.20+$69.12
  3. Washington, DC area · District of Columbia$719.23+$84.15
  4. Miami, FL · Florida$698.78+$63.70
  5. Chicago, IL · Illinois$677.11+$42.03
  6. Manhattan, NY · New York$729.89+$94.81
  7. Alaska · Alaska$731.67+$96.59

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

Every other payment area

46285 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$563.90$385.33
ArkansasArkansas$555.47$380.17
ArizonaArizona$613.11$415.36
Bakersfield, CACalifornia$661.83$438.16
Chico, CACalifornia$659.06$435.39
El Centro, CACalifornia$659.23$435.56
Fresno, CACalifornia$659.06$435.39
Hanford, CACalifornia$659.06$435.39

46285 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.

$555.47

$740.19

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

View every state and territory as a table
46285 office rate range by state
State / territoryOffice rate rangeLocalities
AK$731.671
AL$563.901
AR$555.471
AZ$613.111
CA$659.06–$821.3129
CO$652.791
CT$673.871
DC$719.231
DE$623.431
FL$629.03–$698.783
GA$591.77–$644.862
GU$674.771
HI$674.771
IA$575.171
ID$579.801
IL$612.89–$677.114
IN$583.181
KS$574.081
KY$581.341
LA$581.08–$610.572
MA$649.39–$716.312
MD$635.05–$719.233
ME$584.72–$614.952
MI$598.54–$638.872
MN$619.891
MO$571.91–$610.783
MS$563.721
MT$630.881
NC$590.761
ND$611.301
NE$577.921
NH$644.091
NJ$679.98–$711.752
NM$602.601
NV$625.841
NY$600.05–$750.245
OH$594.541
OK$578.471
OR$619.44–$672.092
PA$594.56–$657.782
PR$635.081
RI$644.631
SC$593.951
SD$608.991
TN$577.271
TX$590.66–$651.978
UT$602.281
VA$614.06–$719.232
VI$635.081
VT$610.391
WA$647.67–$729.392
WI$590.361
WV$589.981
WY$622.351

See 46285 in every payment locality

How the 46285 rate is calculated

Each of 46285’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 · 46285

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

Malpractice0.99

0.99 RVUs× 1.000 GPCI

Adjusted RVUs

18.8900

Conversion factor

$33.4009

Medicare rate

$630.94

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

5,593

Code
46285
Physician work
5.28
Practice expense
12.62
Malpractice
0.99

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 46285 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work5.28× 1.0005.2800
Practice expense12.62× 1.01112.7588
Malpractice0.99× 0.9850.9751
Total RVUs19.0140
Conversion factor× 33.4009

Office rate, Puerto Rico$635.08

Office: (5.28 × 1 + 12.62 × 1.011 + 0.99 × 0.985) × $33.4009 = $635.08

Facility: (5.28 × 1 + 6.51 × 1.011 + 0.99 × 0.985) × $33.4009 = $428.76

Open 46285 in the RVU calculator

Payment rules and modifiers for 46285

46285 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46285

Anal fistula surgery, staged treatment

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 · 46285

Anal fistula surgery, staged treatment

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

46285 without 51 · national office

$630.94

Anal fistula surgery, staged treatment

46285-51 · Second procedure: 50%

$315.47

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 46285

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

Codes related to 46285
CodeHow it relatesOffice range, Puerto Rico
Same family
46270Anal fistula surgery, subcutaneous tractSurgical treatment of a subcutaneous anal fistula, selected by tract anatomy.$603.86
46275Fistula surgery, intersphincteric tractSurgical treatment of an intersphincteric anal fistula.$634.75
46280Anal fistula surgery, complex sphincter-crossing tractSurgical treatment for transsphincteric, suprasphincteric, or extrasphincteric fistulas.No office rate
Used instead
46288Anal fistula repair, advancement flapAnal fistula repair reported for a repair procedure rather than staged seton treatment.No office rate

How 46285 has changed in Puerto Rico

46285 · Office / nonfacility

$635.08

Effective 2026-10-01

The base rate is $80.11 higher than on 2025-10-01, moving from $554.97 to $635.08 (14.4%).

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

    $554.97changed to$635.08

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.42 changed to 5.28
    • Practice expense RVU 10.69 changed to 12.62
    • 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

    $567.77changed to$554.97

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.60 changed to 10.69
    • Malpractice RVU 0.98 changed to 0.99

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $558.50changed to$567.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $575.75changed to$558.50

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.59 changed to 10.60
    • Malpractice RVU 0.91 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

    $573.37changed to$575.75

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

  6. January 1, 2023

    RVU23A

    $589.40changed to$573.37

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.60 changed to 10.59
    • Malpractice RVU 0.94 changed to 0.91
    • 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

    $588.67changed to$589.40

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.46 changed to 10.60
    • Malpractice RVU 0.92 changed to 0.94

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $571.84changed to$588.67

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.47 changed to 10.46
    • Malpractice RVU 0.89 changed to 0.92
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $562.73changed to$571.84

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.17 changed to 9.47
    • Malpractice RVU 0.97 changed to 0.89
    • 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

    $558.85changed to$562.73

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.07 changed to 9.17
    • Malpractice RVU 0.98 changed to 0.97

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $491.28changed to$558.85

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.94 changed to 9.07
    • Malpractice RVU 0.96 changed to 0.98
    • 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

    $427.63changed to$491.28

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.85 changed to 8.94
    • Malpractice RVU 0.97 changed to 0.96
    • 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

    $431.43changed to$427.63

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.96 changed to 8.85
    • Malpractice RVU 0.92 changed to 0.97

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $429.28changed to$431.43

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $422.49changed to$429.28

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.87 changed to 8.96
    • Malpractice RVU 0.87 changed to 0.92
    • 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

    $420.94changed to$422.49

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.92 changed to 8.87
    • Malpractice RVU 0.91 changed to 0.87
    • 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: $420.94

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$635.08$428.76RVU26D
2026-07-01$635.08$428.76RVU26C
2026-04-01$635.08$428.76RVU26B
2026-01-01$635.08$428.76RVU26A
2025-10-01$554.97$421.09RVU25D
2025-07-01$554.97$421.09RVU25C
2025-04-01$554.97$421.09RVU25B
2025-01-01$554.97$421.09RVU25A
2024-10-01$567.77$427.99RVU24D
2024-07-01$567.77$427.99RVU24C
2024-04-01$567.77$427.99RVU24B
2024-03-09$567.77$427.99RVU24AR
2024-01-01$558.50$421.00RVU24A
2023-10-01$575.75$430.58RVU23D
2023-07-01$573.37$429.35RVU23C
2023-04-01$573.37$429.35RVU23B
2023-01-01$573.37$429.35RVU23A
2022-10-01$589.40$436.96RVU22D
2022-07-01$589.40$436.96RVU22C
2022-04-01$589.40$436.96RVU22B
2022-01-01$589.40$436.96RVU22A
2021-10-01$588.67$434.62RVU21D
2021-07-01$588.67$434.62RVU21C
2021-04-01$588.67$434.62RVU21B
2021-01-01$588.67$434.62RVU21A
2020-10-01$571.84$435.06RVU20D
2020-07-01$571.84$435.06RVU20C
2020-04-01$571.84$435.06RVU20B
2020-01-01$571.84$435.06RVU20A
2019-10-01$562.73$433.17RVU19D
2019-07-01$562.73$433.17RVU19C
2019-04-01$562.73$433.17RVU19B
2019-01-01$562.73$433.17RVU19A
2018-10-01$558.85$432.69RVU18D
2018-07-01$558.85$432.69RVU18C
2018-04-01$558.85$432.69RVU18B
2018-01-01$558.85$432.69RVU18AR1
2017-10-01$491.28$386.52RVU17D
2017-07-01$491.28$386.52RVU17C
2017-04-01$491.28$386.52RVU17B
2017-01-01$491.28$386.52RVU17A
2016-10-01$427.63$342.56RVU16D
2016-07-01$427.63$342.56RVU16C
2016-04-01$427.63$342.56RVU16B
2016-01-01$427.63$342.56RVU16A
2015-10-01$431.43$344.54RVU15D
2015-07-01$431.43$344.54RVU15C
2015-04-01$429.28$342.82RVU15B
2015-01-01$429.28$342.82RVU15A
2014-10-01$422.49$339.19RVU14D
2014-07-01$422.49$339.19RVU14C
2014-04-01$422.49$339.19RVU14B
2014-01-01$422.49$339.19RVU14A
2013-10-01$420.94$333.52RVU13D
2013-07-01$420.94$333.52RVU13C
2013-04-01$420.94$333.52RVU13B
2013-01-01$420.94$333.52RVU13AR

Price 46285 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

46285 billing questions

When should I choose 46285 over an anatomy-specific fistula code?

Use 46285 when the operative plan is staged and includes seton placement. Codes 46270, 46275, and 46280 describe treatment selected by fistula anatomy or complexity.

Does 46285 include seton placement?

Yes. Seton placement is part of the staged fistula treatment represented by this code.

What documentation supports 46285?

Document the fistula tract, seton placement, and the plan to treat the fistula in stages. The operative report should identify the work performed during that session.

Can I report modifier 50 for bilateral fistulas?

No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.

Can an assistant or co-surgeon be billed for 46285?

CMS payment for an assistant at surgery is statutorily restricted. Co-surgeon and team-surgery billing are not permitted for this code.

How does the 90-day global period affect follow-up?

The global period includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures occur in the same session, the standard multiple-procedure reduction applies.

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 46285PPRRVU2026_Oct_nonQPP.csv, line 5,593 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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