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Billing code 46744: Cloacal repairMedicare rate & RVUs

Reports partial operative reconstruction of a congenital cloacal anomaly, where the urinary, genital, and intestinal outlets share a common channel.

CMS RVU26DEffective Oct 1, 2026109 payment localities26 Medicare services in 2024

Medicare pays $3,304.02 for 46744 nationally in a facility.

Medicare rate · 46744

Cloacal repair

Work RVUs
57.47
Total RVUs
98.92
Global days
090

National rate · 2026

$3,304.02

Facility setting, before claim adjustments.

See every locality for 46744 →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 46744 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 46744 covers

A cloacal anomaly is a congenital malformation in which the urinary, genital, and intestinal tracts converge into a common channel. Code 46744 describes a partial repair rather than the intermediate or extensive repairs represented by other codes in this series. The operation is typically performed in the operating room by a pediatric surgeon with colorectal expertise, often with pediatric urology or gynecology involvement. It may be part of staged reconstruction for a child with complex congenital pelvic anatomy.

Select the partial-repair level from the operative work performed, not from the diagnosis alone or the planned future stages. The operative report should describe the anatomy, structures addressed, reconstruction completed, and why the service was partial. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires 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 46744 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

46744 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,972.12
Alaska*Unavailable$4,089.57
ArizonaUnavailable$3,203.01
ArkansasUnavailable$2,931.98
AtlantaUnavailable$3,427.02
AustinUnavailable$3,299.74
BakersfieldUnavailable$3,223.06
Baltimore/Surr. CntysUnavailable$3,520.10
BeaumontUnavailable$3,189.18
BrazoriaUnavailable$3,198.45

46744 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
46744 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 46744 rate is calculated

Each of 46744’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 · 46744

RVUs × geographic indexes × conversion factor

Work57.47

57.47 RVUs× 1.000 GPCI

Practice expense26.06

26.06 RVUs× 1.000 GPCI

Malpractice15.39

15.39 RVUs× 1.000 GPCI

Adjusted RVUs

98.9200

Conversion factor

$33.4009

Medicare rate

$3,304.02

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

Payment rules and modifiers for 46744

46744 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46744

Cloacal 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 · 46744

Cloacal 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.

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

46744 without 51 · national facility

$3,304.02

Cloacal repair

46744-51 · Second procedure: 50%

$1,652.01

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

46744 compared with similar codes

Compare codes · National

4 codes, side by side

  • 46744

    Cloacal repair57.47 wRVU

    Not priced

  • 46746

    Cloacal repair63.8 wRVU

    Not priced

  • 46748

    Cloacal repair69.63 wRVU

    Not priced

  • 46742

    Anorectal repair39.14 wRVU

    Not priced

How to choose

46746Cloacal repair
Use 46744 for partial cloacal repair and 46746 for intermediate repair. The operative report should support the selected level.
46748Cloacal repair
46748 represents extensive cloacal repair, whereas 46744 is for partial repair. Select by the extent of reconstruction performed.
46742Anorectal repair
46742 addresses imperforate anus. Use 46744 when the operation treats a cloacal anomaly involving a common outlet, rather than an imperforate anus alone.

Codes related to 46744

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

Codes related to 46744
CodeHow it relatesNational office range
Same family
46746Cloacal repairIntermediate cloacal anomaly repair; distinguish by the documented extent of reconstruction.No office rate
46748Cloacal repairExtensive cloacal anomaly repair; distinguish by the documented extent of reconstruction.No office rate
Used instead
46742Anorectal repairFor repair of imperforate anus rather than partial repair of a cloacal anomaly.No office rate
46730AnoplastyFor construction of an absent anus, a different congenital anorectal condition.No office rate

46744 billing questions

How does 46744 differ from 46746 and 46748?

46744 represents partial repair; 46746 and 46748 represent intermediate and extensive repair, respectively. Match the code to the operative extent documented, not simply to the cloacal diagnosis.

Is 46744 an add-on code?

No. It reports the partial cloacal repair itself and is not an add-on to another primary procedure.

What documentation supports the partial-repair level?

Document the congenital anatomy, the structures reconstructed during the session, the extent of repair completed, and any staged plan that explains why the operation was partial.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.

How are assistant and co-surgeon services handled?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

What does the 90-day global period include?

It includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the standard multiple-procedure reduction applies.

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 46744PPRRVU2026_Oct_nonQPP.csv, line 5,621 (RVU26D)

Open CMS sourceHow we calculate rates

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