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Billing code 46716: Anorectal repairMedicare rate & RVUs

Surgical repair for imperforate anus with an anoperineal or vestibular fistula, selected according to the congenital anatomy documented by the surgeon.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,215.12 for 46716 nationally in a facility.

Medicare rate · 46716

Anorectal repair

Swap in your local Medicare rate.

Work RVUs
17.1
Total RVUs
36.38
Global days
090

National rate · 2026

$1,215.12

Facility setting, before claim adjustments.

See every locality for 46716 → · 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 46716 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 46716 covers

This code describes operative correction of imperforate anus when the congenital anorectal opening communicates through an anoperineal or vestibular fistula. A pediatric surgeon or colorectal surgeon typically performs the reconstruction in an operating room, often as part of treatment for an anorectal malformation identified in infancy or childhood. The operative report should establish the congenital defect and the fistula’s site; an acquired fistula-in-ano is a different clinical problem.

Select the code from the documented malformation and fistula anatomy, rather than from the repair’s general complexity alone. The 90-day global period includes the day-before preoperative visit and 90 days of 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 code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is 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 46716 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

46716 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,087.46
Alaska*Unavailable$1,464.10
ArizonaUnavailable$1,177.91
ArkansasUnavailable$1,071.82
AtlantaUnavailable$1,255.38
AustinUnavailable$1,227.36
BakersfieldUnavailable$1,213.46
Baltimore/Surr. CntysUnavailable$1,296.31
BeaumontUnavailable$1,160.07
BrazoriaUnavailable$1,181.69

46716 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
46716 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 46716 rate is calculated

Each of 46716’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 · 46716

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 17.10Practice expense 14.71Malpractice 4.57

36.3800 adjusted RVUs×$33.4009 conversion factor=$1,215.12

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

Payment rules and modifiers for 46716

46716 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46716

Anorectal 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)1Permitted with supporting documentation.
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 · 46716

Anorectal 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

46716 without 51 · national facility

$1,215.12

Anorectal repair

46716-51 · Second procedure: 50%

$607.56

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

46716 compared with similar codes

Compare codes

46716 vs 46715 vs 46742 vs 46706 vs 46707: national Medicare rates

Swap in your local Medicare rate.

  • 46716
    Anorectal repair · 17.1 wRVU
    —
  • 46715
    Fistula repair · 7.43 wRVU
    —
  • 46742
    Anorectal repair · 39.14 wRVU
    —
  • 46706
    Fistula repair · 2.38 wRVU
    —
  • 46707
    Fistula repair · 6.23 wRVU
    —

How to choose

46715Fistula repair
Both codes address imperforate anus with fistula anatomy. Distinguish them using the specific fistula type documented in the operative report.
46742Anorectal repair
This code identifies the anoperineal or vestibular fistula context; 46742 is a separate imperforate-anus repair code, selected according to its documented anatomy and procedure.
46706Fistula repair
46706 describes treatment of an anorectal fistula using fibrin glue. It is not the congenital imperforate-anus repair represented here.
46707Fistula repair
46707 uses a plug to treat an anorectal fistula; this code is for congenital imperforate anus associated with an anoperineal or vestibular fistula.

Codes related to 46716

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

Codes related to 46716
CodeHow it relatesNational office range
Same family
46715Fistula repairRelated imperforate-anus repair code; distinguish the documented fistula anatomy.No office rate
46742Anorectal repairAnother repair code for imperforate anus, selected for the documented malformation.No office rate
46730AnoplastyConstruction of an absent anus rather than this fistula-associated repair.No office rate
46735Anorectal reconstructionRelated absent-anus construction code for a different congenital repair.No office rate
46740AnoplastyAnother absent-anus construction code within the congenital anorectal surgery family.No office rate
Used instead
46706Fistula repairFibrin-glue treatment is for an anorectal fistula, not congenital imperforate anus repair.No office rate
46707Fistula repairFistula-plug treatment addresses an anorectal fistula rather than this congenital malformation.No office rate

46716 billing questions

How is this different from code 46715?

Both concern congenital imperforate anus with fistula anatomy. Use the documented fistula type to distinguish the anoperineal category from the anoperineal or vestibular category represented by this code.

Is this for an acquired fistula-in-ano?

No. This code is for repair of imperforate anus associated with a congenital anoperineal or vestibular fistula, not a typical acquired anal fistula.

Can a separate fistula procedure be reported at the same session?

Report another procedure only when the surgeon documents a distinct service beyond the repair represented by this code. When multiple procedures are performed in the same session, CMS applies the standard multiple procedure reduction.

Should modifier 50 be used for a bilateral repair?

No. Modifier 50 is inappropriate for this code’s descriptor and anatomy.

What documentation supports code selection?

The operative report should identify imperforate anus and describe the fistula’s site and the repair performed. Those anatomic details distinguish this service from other congenital anorectal repairs.

How are assistant and co-surgeon services treated?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is 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
RVUs for 46716PPRRVU2026_Oct_nonQPP.csv, line 5,616 (RVU26D)

Open CMS sourceHow we calculate rates

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