CPT code 46706: Fistula repair, glue technique2026 Medicare rate & RVUs in Guam
Reports operative closure of an anal fistula using glue, typically selected when the surgeon treats the tract with a sealant rather than a plug.
CMS doesn’t publish an office rate for 46706 in Guam.
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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What 46706 covers
A colorectal or general surgeon uses this procedure to close an anal fistula by preparing the tract and instilling glue as a sealant. It is performed in an operative setting for a patient with a fistulous tract connecting the anal canal and perianal skin. The glue technique aims to close the tract without using a plug or performing a sphincter-cutting fistulotomy.
Report the code when the operative note supports treatment of the anal fistula with glue; document the tract treated and the sealant technique. This code has a 10-day global period, so related postoperative visits during that period are included. 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 multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, 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.
46706 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $179.97 |
How the 46706 rate is calculated
Each of 46706’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 · 46706
RVUs × geographic indexes × conversion factor
Work2.38
2.38 RVUs× 1.000 GPCI
Practice expense2.33
2.33 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
5.3300
Conversion factor
$33.4009
Medicare rate
$178.03
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46706
46706 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46706
Fistula repair, glue technique
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46706
Fistula repair, glue technique
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46706 without 51 · national facility
$178.03
Fistula repair, glue technique
46706-51 · Second procedure: 50%
$89.02
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%).
46706 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46707Fistula repairAnorectal tract, plug
- Choose 46706 for glue-based closure and 46707 for repair using a plug. The documented method distinguishes the two.
- 46275Fistula surgeryIntersphincteric tract
- 46275 is for surgical treatment of an intersphincteric anal fistula. Use 46706 when the surgeon's repair method is glue.
- 46280Anal fistula surgeryComplex sphincter-crossing tract
- 46280 applies to surgical treatment of specified complex fistula anatomy, including transsphincteric and more extensive tracts. 46706 identifies repair with glue.
46706 billing questions
How is this different from 46707?
46706 describes repair using glue; 46707 is the anal fistula repair code for a plug. The operative technique documented determines which code fits.
Can a fistulotomy be reported instead?
A fistulotomy code describes a different operative approach. Use 46706 when the surgeon repairs the tract with glue, rather than laying open the tract.
Are related postoperative visits separately billable?
Related postoperative visits during the 10-day global period are included in this procedure's payment.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this procedure.
What should the operative note support?
Document the anal fistula treated and that glue was used to close the tract. The note should distinguish the glue technique from plug placement or fistulotomy.
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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