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CPT code 46285: Anal fistula surgery, staged treatment2026 Medicare rate & RVUs in Galveston, TX

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 Galveston, TX, Medicare pays $623.72 for 46285 in the office and $421.06 when it’s performed in a hospital or facility.

$623.72Office (non-facility)
$421.06Hospital or facility
−1.1%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 Galveston, TX
  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 Galveston, TX 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. Galveston, TX pays $623.72. The RVUs are the same everywhere; the geographic indexes change the dollars.

46285 in Galveston, TX vs other payment areas
  1. Galveston, TX · this page$623.72
  2. Austin, TX · Texas$651.97+$28.25
  3. Beaumont, TX · Texas$590.66−$33.06
  4. Brazoria, TX · Texas$621.29−$2.43
  5. Dallas, TX · Texas$626.15+$2.43
  6. Fort Worth, TX · Texas$622.36−$1.36
  7. Houston, TX · Texas$641.84+$18.12

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

Every other payment area

46285 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$606.24$412.57
Los Angeles, CACalifornia$704.20$462.78
Washington, DC areaDistrict of Columbia$719.23$478.83
Miami, FLFlorida$698.78$486.34
Chicago, ILIllinois$677.11$472.01
Manhattan, NYNew York$729.89$492.75
AlaskaAlaska$731.67$514.33
AlabamaAlabama$563.90$385.33

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 Galveston, TX 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

101

Locality
Galveston, TX
Physician work
1.008
Practice expense
0.993
Malpractice
0.828
Office calculation for 46285 in Galveston, TX
ComponentRVULocality factorAdjusted
Physician work5.28× 1.0085.3222
Practice expense12.62× 0.99312.5317
Malpractice0.99× 0.8280.8197
Total RVUs18.6736
Conversion factor× 33.4009

Office rate, Galveston, TX$623.72

Office: (5.28 × 1.008 + 12.62 × 0.993 + 0.99 × 0.828) × $33.4009 = $623.72

Facility: (5.28 × 1.008 + 6.51 × 0.993 + 0.99 × 0.828) × $33.4009 = $421.06

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, Galveston, TX
Same family
46270Anal fistula surgery, subcutaneous tractSurgical treatment of a subcutaneous anal fistula, selected by tract anatomy.$592.63
46275Fistula surgery, intersphincteric tractSurgical treatment of an intersphincteric anal fistula.$623.44
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 Galveston, TX

46285 · Office / nonfacility

$623.72

Effective 2026-10-01

The base rate is $72.78 higher than on 2025-10-01, moving from $550.94 to $623.72 (13.2%).

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

    $550.94changed to$623.72

    • 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
    • Work GPCI 1.014 changed to 1.008
    • Practice expense GPCI 1.000 changed to 0.993
    • Malpractice GPCI 0.855 changed to 0.828

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $563.68changed to$550.94

    • 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

    $554.48changed to$563.68

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $573.10changed to$554.48

    • 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
    • Work GPCI 1.023 changed to 1.014
    • Practice expense GPCI 1.013 changed to 1.000
    • Malpractice GPCI 0.703 changed to 0.855

  5. January 1, 2023

    RVU23A

    $587.82changed to$573.10

    • 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
    • Work GPCI 1.032 changed to 1.023
    • Practice expense GPCI 1.026 changed to 1.013
    • Malpractice GPCI 0.550 changed to 0.703

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $587.30changed to$587.82

    • 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.

  7. January 1, 2021

    RVU21A

    $571.28changed to$587.30

    • 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
    • Work GPCI 1.026 changed to 1.032
    • Practice expense GPCI 1.019 changed to 1.026
    • Malpractice GPCI 0.695 changed to 0.550

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $562.68changed to$571.28

    • 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
    • Work GPCI 1.020 changed to 1.026
    • Practice expense GPCI 1.011 changed to 1.019
    • Malpractice GPCI 0.839 changed to 0.695

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $558.73changed to$562.68

    • 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.

  10. January 1, 2018

    RVU18AR1

    $554.01changed to$558.73

    • 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 1.012 changed to 1.011
    • Malpractice GPCI 0.897 changed to 0.839

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $551.90changed to$554.01

    • 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
    • Work GPCI 1.019 changed to 1.020
    • Practice expense GPCI 1.013 changed to 1.012
    • Malpractice GPCI 0.955 changed to 0.897

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $556.18changed to$551.90

    • 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.

  13. July 1, 2015

    RVU15C

    $553.41changed to$556.18

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $546.45changed to$553.41

    • 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
    • Work GPCI 1.014 changed to 1.019
    • Practice expense GPCI 1.005 changed to 1.013
    • Malpractice GPCI 0.970 changed to 0.955

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $552.72changed to$546.45

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 0.996 changed to 1.005
    • Malpractice GPCI 0.985 changed to 0.970

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $552.72

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$623.72$421.06RVU26D
2026-07-01$623.72$421.06RVU26C
2026-04-01$623.72$421.06RVU26B
2026-01-01$623.72$421.06RVU26A
2025-10-01$550.94$417.99RVU25D
2025-07-01$550.94$417.99RVU25C
2025-04-01$550.94$417.99RVU25B
2025-01-01$550.94$417.99RVU25A
2024-10-01$563.68$424.87RVU24D
2024-07-01$563.68$424.87RVU24C
2024-04-01$563.68$424.87RVU24B
2024-03-09$563.68$424.87RVU24AR
2024-01-01$554.48$417.94RVU24A
2023-10-01$573.10$427.21RVU23D
2023-07-01$573.10$427.21RVU23C
2023-04-01$573.10$427.21RVU23B
2023-01-01$573.10$427.21RVU23A
2022-10-01$587.82$432.66RVU22D
2022-07-01$587.82$432.66RVU22C
2022-04-01$587.82$432.66RVU22B
2022-01-01$587.82$432.66RVU22A
2021-10-01$587.30$430.49RVU21D
2021-07-01$587.30$430.49RVU21C
2021-04-01$587.30$430.49RVU21B
2021-01-01$587.30$430.49RVU21A
2020-10-01$571.28$433.00RVU20D
2020-07-01$571.28$433.00RVU20C
2020-04-01$571.28$433.00RVU20B
2020-01-01$571.28$433.00RVU20A
2019-10-01$562.68$432.61RVU19D
2019-07-01$562.68$432.61RVU19C
2019-04-01$562.68$432.61RVU19B
2019-01-01$562.68$432.61RVU19A
2018-10-01$558.73$432.07RVU18D
2018-07-01$558.73$432.07RVU18C
2018-04-01$558.73$432.07RVU18B
2018-01-01$558.73$432.07RVU18AR1
2017-10-01$554.01$430.16RVU17D
2017-07-01$554.01$430.16RVU17C
2017-04-01$554.01$430.16RVU17B
2017-01-01$554.01$430.16RVU17A
2016-10-01$551.90$429.67RVU16D
2016-07-01$551.90$429.67RVU16C
2016-04-01$551.90$429.67RVU16B
2016-01-01$551.90$429.67RVU16A
2015-10-01$556.18$431.33RVU15D
2015-07-01$556.18$431.33RVU15C
2015-04-01$553.41$429.18RVU15B
2015-01-01$553.41$429.18RVU15A
2014-10-01$546.45$425.48RVU14D
2014-07-01$546.45$425.48RVU14C
2014-04-01$546.45$425.48RVU14B
2014-01-01$546.45$425.48RVU14A
2013-10-01$552.72$424.29RVU13D
2013-07-01$552.72$424.29RVU13C
2013-04-01$552.72$424.29RVU13B
2013-01-01$552.72$424.29RVU13AR

Price 46285 for an earlier date of service

Where the Galveston, TX rate applies

Galveston, TX is a Medicare payment area, not a city. Our Census mapping connects it to 16 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

  • Galveston
  • Bacliff
  • Bayou Vista
  • Bolivar Peninsula
  • Clear Lake Shores
  • Dickinson
  • 46285 in Friendswood · multiple payment areas
  • Hitchcock

Browse all communities in Texas

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 Galveston, TXGPCI2026.csv, line 101 (RVU26D)

Open CMS sourceHow we calculate rates

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