FeeBase
Log inGet started
Menu

Billing code 46020: Seton placementMedicare rate & RVUs

Reports placement of a loop through an anal fistula tract to maintain drainage, often as part of staged management of complex fistula disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.4K Medicare services in 2024

Medicare pays $110.89 for 46020 nationally in a facility.

Medicare rate · 46020

Seton placement

Work RVUs
1.81
Total RVUs
3.32
Global days
000

National rate · 2026

$110.89

Facility setting, before claim adjustments.

See every locality for 46020 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 46020 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 46020 covers

A surgeon passes a loop through an anal fistula tract and secures it so the tract remains open for drainage. Colorectal and general surgeons commonly perform this procedure for fistulas managed in stages, including situations where immediate division of the tract is not the treatment plan. It is performed in an operating room or other procedural setting, depending on the patient and clinical circumstances.

Report 46020 for placing the seton, not for removing one or draining an abscess alone. The operative note should identify the fistula tract and document the seton placement. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery reporting 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 46020 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

46020 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$100.87
Alaska*Unavailable$138.22
ArizonaUnavailable$107.97
ArkansasUnavailable$99.64
AtlantaUnavailable$114.10
AustinUnavailable$111.87
BakersfieldUnavailable$111.03
Baltimore/Surr. CntysUnavailable$117.51
BeaumontUnavailable$106.58
BrazoriaUnavailable$108.38

46020 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.

View every state and territory as a table
46020 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 46020 rate is calculated

Each of 46020’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 · 46020

RVUs × geographic indexes × conversion factor

Work1.81

1.81 RVUs× 1.000 GPCI

Practice expense1.15

1.15 RVUs× 1.000 GPCI

Malpractice0.36

0.36 RVUs× 1.000 GPCI

Adjusted RVUs

3.3200

Conversion factor

$33.4009

Medicare rate

$110.89

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 46020

The CMS indicators that decide how 46020 is paid alongside other services.

CMS payment indicators · 46020

Seton placement

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46020 without 51 · national facility

$110.89

Seton placement

46020-51 · Second procedure: 50%

$55.45

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

46020 compared with similar codes

Compare codes · National

4 codes, side by side

  • 46020

    Seton placement1.81 wRVU

    Not priced

  • 46030

    Seton removal1.44 wRVU

    $283.91

  • 46040

    Abscess drainage5.24 wRVU

    $630.27

  • 46270

    Anal fistula surgery4.8 wRVU

    $599.88

How to choose

46030Seton removal
46020 reports placement of a seton; 46030 reports removal of an anal seton. Use the code matching the work performed during the encounter.
46040Abscess drainage
46040 describes incision and drainage of an ischiorectal or perirectal abscess. It is not a substitute for documenting placement of a seton through a fistula tract.
46270Anal fistula surgery
46270 applies when a superficial anal fistula is treated by opening the tract. Choose 46020 when the documented service is seton placement.

Codes related to 46020

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

Codes related to 46020
CodeHow it relatesNational office range
Used instead
46270Anal fistula surgeryFor a superficial anal fistula treated by opening the tract rather than placing a seton.$526.53–$781.84
46275Fistula surgeryFor an intersphincteric fistula treated by fistulotomy or fistulectomy instead of seton placement.$555.30–$821.13
46280Anal fistula surgeryFor certain deeper or more extensive anal fistulas treated by fistulotomy or fistulectomy.No office rate

46020 billing questions

How does seton placement differ from fistulotomy?

46020 reports placement of a loop to keep the fistula tract draining. A fistulotomy code describes opening the tract as the operative treatment, rather than placing a seton.

Can an abscess drainage code also be reported?

A separate abscess drainage service may be relevant when an abscess is also treated, but the documentation should support that distinct work. Seton placement alone does not describe abscess drainage.

Is modifier 50 appropriate?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure's 0-day global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons and team surgery are not permitted for this code.

What happens when another procedure is performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 46020PPRRVU2026_Oct_nonQPP.csv, line 5,570 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 46020 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 46020 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →