Billing code 46746: Cloacal repairMedicare rate & RVUs

Medicare pays $3,628.67 for 46746 nationally in a facility.

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

What 46746 covers

This code describes operative reconstruction of a congenital cloacal malformation through an abdominal approach. In this rare anomaly, the urinary, genital, and intestinal tracts converge into a shared channel or opening. The procedure is generally performed in a hospital operating room by a pediatric colorectal or general surgeon, sometimes with pediatric urology or gynecology expertise involved based on the anatomy and operative plan.

Select this code when the operative report documents repair of a cloacal anomaly using an abdominal approach; the perineal-only and combined abdominal-perineal approaches have separate sibling codes. Documentation should identify the anomaly, operative route, reconstructive work, and any separately participating surgeons. CMS classifies the service as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 46746 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

46746 rates by state

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

How the 46746 rate is calculated

Each of 46746’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.

Payment rules and modifiers for 46746

46746 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

46746 compared with similar codes

How to choose

46744Cloacal repair

This code is for the abdominal approach; 46744 is used when the cloacal repair is performed through a perineal approach.

46748Cloacal repair

Use 46748 when the repair uses both abdominal and perineal approaches. This code identifies the abdominal approach.

46742Anorectal repair

46742 is for repair of imperforate anus. Use this code when the operative diagnosis and repair are for a cloacal anomaly.

Codes related to 46746

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

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

Open CMS sourceHow we calculate rates