Billing code 46270: Anal fistula surgeryMedicare rate & RVUs
Reports surgical treatment of a superficial anal fistula confined to the subcutaneous tissue, without a deeper tract involving the sphincter muscles.
Medicare pays $599.88 for 46270 nationally in the office and $408.16 in a hospital or facility. Local office rates run $526.53–$781.84.
Medicare rate · 46270
Anal fistula surgery
Swap in your local Medicare rate.
- Work RVUs
- 4.8
- Total RVUs
- 17.96
- Global days
- 090
National rate · 2026
$599.88
Office setting, before claim adjustments.
See every locality for 46270 → · 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
What 46270 covers
This service treats a superficial anal fistula whose tract is confined to tissue beneath the skin around the anus. The surgeon opens or excises the tract to treat the fistula. Colorectal and general surgeons typically perform the procedure in an operating room or ambulatory surgery setting. The operative note should establish the tract’s course and its relationship to the sphincter muscles.
Select this code by the documented anatomy and extent of the fistula, not simply by the fact that a fistula was treated. A tract involving the sphincter or a complex course points to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 for this service. Medicare does not pay an assistant at surgery; 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.
Where 46270 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$526.53 to $781.84
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $534.72 | $366.96 |
| Alaska* | $691.62 | $487.43 |
| Arizona | $582.52 | $396.74 |
| Arkansas | $526.53 | $361.84 |
| Atlanta | $613.51 | $418.72 |
| Austin | $620.01 | $417.17 |
| Bakersfield | $629.02 | $418.89 |
| Baltimore/Surr. Cntys | $639.96 | $434.24 |
| Beaumont | $560.95 | $386.48 |
| Brazoria | $590.23 | $400.23 |
| Chicago | $645.86 | $453.18 |
| Chico | $626.29 | $416.16 |
| Colorado | $620.58 | $416.59 |
| Connecticut | $641.33 | $434.85 |
| Dallas | $595.00 | $404.05 |
| Dc + Md/Va Suburbs | $684.63 | $458.78 |
| Delaware | $592.46 | $403.04 |
| Detroit | $608.34 | $423.33 |
| East St. Louis | $600.89 | $424.51 |
| El Centro | $626.45 | $416.32 |
| Fort Lauderdale | $631.88 | $437.67 |
| Fort Worth | $591.37 | $402.33 |
| Fresno | $626.29 | $416.16 |
| Galveston | $592.63 | $402.25 |
| Hanford-Corcoran | $626.29 | $416.16 |
| Hawaii, Guam | $641.65 | $423.66 |
| Houston | $610.75 | $420.37 |
| Idaho | $549.93 | $373.55 |
| Indiana | $553.21 | $375.48 |
| Iowa | $545.39 | $369.96 |
| Kansas | $544.46 | $371.14 |
| Kentucky | $551.95 | $381.51 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $669.73 | $442.92 |
| Madera | $626.29 | $416.16 |
| Manhattan | $695.37 | $472.59 |
| Merced | $626.29 | $416.16 |
| Metropolitan Boston | $681.67 | $452.76 |
| Metropolitan Kansas City | $574.32 | $394.30 |
| Metropolitan Philadelphia | $625.81 | $426.23 |
| Metropolitan St. Louis | $580.43 | $397.92 |
| Miami | $667.11 | $467.52 |
| Minnesota | $588.39 | $391.11 |
| Mississippi | $534.75 | $369.68 |
| Modesto | $626.29 | $416.16 |
| Montana** | $599.81 | $408.09 |
| Napa | $722.98 | $470.29 |
| Nebraska | $548.01 | $371.05 |
| Nevada** | $594.76 | $402.85 |
| New Hampshire | $612.41 | $412.83 |
| New Mexico | $572.79 | $396.98 |
| New Orleans | $580.39 | $399.98 |
| North Carolina | $560.71 | $381.83 |
| North Dakota** | $580.24 | $388.52 |
| Northern Nj | $677.27 | $454.87 |
| Nyc Suburbs/Long Island | $715.31 | $487.35 |
| Ohio | $564.78 | $389.74 |
| Oklahoma | $549.01 | $377.80 |
| Oxnard-Thousand Oaks-Ventura | $665.88 | $439.27 |
| Portland | $639.10 | $426.10 |
| Poughkpsie/N Nyc Suburbs | $652.66 | $442.72 |
| Puerto Rico | $603.86 | $410.03 |
| Queens | $698.74 | $472.12 |
| Redding | $626.29 | $416.16 |
| Rest Of California | $626.29 | $416.16 |
| Rest Of Florida | $598.63 | $415.34 |
| Rest Of Georgia | $562.33 | $391.31 |
| Rest Of Illinois | $583.13 | $408.09 |
| Rest Of Louisiana | $551.75 | $382.07 |
| Rest Of Maine | $554.86 | $378.48 |
| Rest Of Maryland | $603.65 | $409.63 |
| Rest Of Massachusetts | $617.28 | $415.39 |
| Rest Of Michigan | $568.78 | $393.74 |
| Rest Of Missouri | $542.92 | $377.66 |
| Rest Of New Jersey | $646.90 | $437.54 |
| Rest Of New York | $569.73 | $387.60 |
| Rest Of Oregon | $588.43 | $397.48 |
| Rest Of Pennsylvania | $564.73 | $388.73 |
| Rest Of Texas | $575.94 | $394.00 |
| Rest Of Washington | $615.61 | $413.72 |
| Rhode Island | $612.77 | $414.72 |
| Riverside-San Bernardino-Ontario | $636.93 | $426.80 |
| Sacramento-Roseville-Folsom | $656.57 | $433.59 |
| Salinas | $654.14 | $431.93 |
| San Diego-Chula Vista-Carlsbad | $669.22 | $439.92 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $763.88 | $493.56 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $762.76 | $492.43 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $781.84 | $505.38 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $777.24 | $500.78 |
| San Luis Obispo-Paso Robles | $643.76 | $425.39 |
| Santa Cruz-Watsonville | $675.30 | $442.36 |
| Santa Maria-Santa Barbara | $656.50 | $432.96 |
| Santa Rosa-Petaluma | $682.03 | $446.59 |
| Seattle (King Cnty) | $694.12 | $458.88 |
| South Carolina | $564.03 | $386.88 |
| South Dakota** | $577.92 | $386.20 |
| Southern Maine | $584.02 | $394.02 |
| Stockton | $626.29 | $416.16 |
| Suburban Chicago | $637.51 | $440.61 |
| Tennessee | $547.58 | $373.31 |
| Utah | $572.12 | $391.90 |
| Vallejo | $721.35 | $468.67 |
| Vermont | $579.48 | $389.68 |
| Virgin Islands | $603.86 | $410.03 |
| Virginia | $583.25 | $394.79 |
| Visalia | $626.29 | $416.16 |
| West Virginia | $560.88 | $394.28 |
| Wisconsin | $559.93 | $376.26 |
| Wyoming** | $591.28 | $399.56 |
| Yuba City | $626.29 | $416.16 |
46270 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$526.53
$704.07
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $691.62 | 1 |
| AL | $534.72 | 1 |
| AR | $526.53 | 1 |
| AZ | $582.52 | 1 |
| CA | $626.29–$781.84 | 29 |
| CO | $620.58 | 1 |
| CT | $641.33 | 1 |
| DC | $684.63 | 1 |
| DE | $592.46 | 1 |
| FL | $598.63–$667.11 | 3 |
| GA | $562.33–$613.51 | 2 |
| GU | $641.65 | 1 |
| HI | $641.65 | 1 |
| IA | $545.39 | 1 |
| ID | $549.93 | 1 |
| IL | $583.13–$645.86 | 4 |
| IN | $553.21 | 1 |
| KS | $544.46 | 1 |
| KY | $551.95 | 1 |
| LA | $551.75–$580.39 | 2 |
| MA | $617.28–$681.67 | 2 |
| MD | $603.65–$684.63 | 3 |
| ME | $554.86–$584.02 | 2 |
| MI | $568.78–$608.34 | 2 |
| MN | $588.39 | 1 |
| MO | $542.92–$580.43 | 3 |
| MS | $534.75 | 1 |
| MT | $599.81 | 1 |
| NC | $560.71 | 1 |
| ND | $580.24 | 1 |
| NE | $548.01 | 1 |
| NH | $612.41 | 1 |
| NJ | $646.90–$677.27 | 2 |
| NM | $572.79 | 1 |
| NV | $594.76 | 1 |
| NY | $569.73–$715.31 | 5 |
| OH | $564.78 | 1 |
| OK | $549.01 | 1 |
| OR | $588.43–$639.10 | 2 |
| PA | $564.73–$625.81 | 2 |
| PR | $603.86 | 1 |
| RI | $612.77 | 1 |
| SC | $564.03 | 1 |
| SD | $577.92 | 1 |
| TN | $547.58 | 1 |
| TX | $560.95–$620.01 | 8 |
| UT | $572.12 | 1 |
| VA | $583.25–$684.63 | 2 |
| VI | $603.86 | 1 |
| VT | $579.48 | 1 |
| WA | $615.61–$694.12 | 2 |
| WI | $559.93 | 1 |
| WV | $560.88 | 1 |
| WY | $591.28 | 1 |
How the 46270 rate is calculated
Each of 46270’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 · 46270
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.80Practice expense 12.17Malpractice 0.99
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46270
46270 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46270
Anal fistula surgery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46270
Anal fistula surgery
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46270 without 51 · national office
$599.88
Anal fistula surgery
46270-51 · Second procedure: 50%
$299.94
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%).
46270 compared with similar codes
Compare codes
46270 vs 46275 vs 46280 vs 46285: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46275Fistula surgery
- Use 46270 for a tract limited to subcutaneous tissue; 46275 is for an intersphincteric tract.
- 46280Anal fistula surgery
- 46270 identifies a subcutaneous tract, while 46280 is for a complex fistula. The operative findings determine which anatomy is documented.
- 46285Anal fistula surgery
- 46285 describes staged fistula treatment. 46270 is selected for a subcutaneous fistula treated surgically, not because treatment is staged.
46270 billing questions
How does 46270 differ from 46275?
46270 is for a fistula confined to subcutaneous tissue. Use 46275 when the documented tract is intersphincteric.
When is 46280 a better fit?
46280 describes treatment of a complex anal fistula. Choose based on the documented tract anatomy and complexity rather than the procedure name alone.
Can 46270 be reported with modifier 50?
No. The anatomy and service do not support bilateral adjustment, so modifier 50 is inappropriate.
What documentation supports 46270?
Document the fistula tract’s course, its depth and relationship to the sphincter muscles, and the surgical treatment performed.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Can an assistant surgeon or co-surgeon be paid for 46270?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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
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