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Billing code 46715: Fistula repairMedicare rate & RVUs

Reports surgical repair of a perineal anorectal fistula, typically associated with a congenital anorectal malformation and treated by a colorectal or pediatric surgeon.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $554.12 for 46715 nationally in a facility.

Medicare rate · 46715

Fistula repair

Swap in your local Medicare rate.

Work RVUs
7.43
Total RVUs
16.59
Global days
090

National rate · 2026

$554.12

Facility setting, before claim adjustments.

See every locality for 46715 → · 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 46715 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 46715 covers

This service repairs a fistulous connection between the anorectal tract and the perineal skin. It is most often performed for a congenital anorectal malformation, commonly in a pediatric patient, by a pediatric surgeon or colorectal surgeon in an operating room. The surgeon identifies and separates the tract and reconstructs the anorectal opening as needed to establish the intended anatomy.

Select the code when the operative report documents repair of a perineal anorectal fistula; the fistula’s anatomy and the procedure performed should support that choice. Distinguish a vestibular fistula, which is addressed by a neighboring code. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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 anatomy. Assistant-at-surgery payment may be allowed; 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 46715 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

46715 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$495.44
Alaska*Unavailable$664.10
ArizonaUnavailable$537.16
ArkansasUnavailable$488.23
AtlantaUnavailable$572.00
AustinUnavailable$560.99
BakersfieldUnavailable$556.00
Baltimore/Surr. CntysUnavailable$591.27
BeaumontUnavailable$527.84
BrazoriaUnavailable$539.40

46715 rates by state

Office rate range in each state. Select a state to see its payment localities.

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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
46715 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 46715 rate is calculated

Each of 46715’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 · 46715

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.43Practice expense 7.18Malpractice 1.98

16.5900 adjusted RVUs×$33.4009 conversion factor=$554.12

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 46715

46715 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46715

Fistula repair

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)2Paid.
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 · 46715

Fistula repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

46715 without 51 · national facility

$554.12

Fistula repair

46715-51 · Second procedure: 50%

$277.06

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

46715 compared with similar codes

Compare codes

46715 vs 46716 vs 46706 vs 46707: national Medicare rates

Swap in your local Medicare rate.

  • 46715
    Fistula repair · 7.43 wRVU
    —
  • 46716
    Anorectal repair · 17.1 wRVU
    —
  • 46706
    Fistula repair · 2.38 wRVU
    —
  • 46707
    Fistula repair · 6.23 wRVU
    —

How to choose

46716Anorectal repair
This code addresses a perineal anorectal fistula. Choose 46716 when the operative documentation identifies the vestibular fistula anatomy associated with that code.
46706Fistula repair
46706 describes treatment of an anal fistula with fibrin glue. This code is for surgical repair of a perineal anorectal fistula, not glue treatment.
46707Fistula repair
46707 is a plug-based anorectal fistula repair. Use this code for the perineal anorectal fistula repair documented in the operative report, not a plug procedure.

Codes related to 46715

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

Codes related to 46715
CodeHow it relatesNational office range
Same family
46716Anorectal repairNearby repair code for perineal anorectal fistula anatomy that includes a vestibular fistula.No office rate
Used instead
46706Fistula repairFibrin glue treatment is a different approach for an anal fistula, rather than this anatomic repair.No office rate
46707Fistula repairA plug-based anorectal fistula repair is a different treatment method.No office rate

46715 billing questions

How is this code distinguished from 46716?

Use this code for repair of a perineal anorectal fistula. Code 46716 is the nearby choice when the documented anatomy includes a vestibular fistula.

Does the 90-day global period include postoperative visits?

Yes. Related postoperative care for 90 days is included, along with the day-before preoperative visit.

Can modifier 50 be used for a fistula on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code’s descriptor and anatomy.

May an assistant surgeon be reported?

Assistant-at-surgery payment may be available. CMS does not permit co-surgeons or team surgery for this code.

What documentation supports choosing this code?

The operative report should identify the perineal anorectal fistula, describe its anatomy, and document the repair performed. Include enough detail to distinguish it from a vestibular fistula or a different fistula-treatment method.

How are other procedures in the same session paid?

CMS pays the highest-valued procedure in full and applies the standard multiple procedure reduction to the other procedures in that session.

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 46715PPRRVU2026_Oct_nonQPP.csv, line 5,615 (RVU26D)

Open CMS sourceHow we calculate rates

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