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Billing code 46748: Cloacal repairMedicare rate & RVUs

Reports definitive reconstruction of a congenital cloacal anomaly when the surgeon uses both abdominal and perineal approaches during the repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $3,922.94 for 46748 nationally in a facility.

Medicare rate · 46748

Cloacal repair

Work RVUs
69.63
Total RVUs
117.45
Global days
090

National rate · 2026

$3,922.94

Facility setting, before claim adjustments.

See every locality for 46748 →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 46748 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 46748 covers

A cloacal anomaly is a congenital malformation in which the urinary, genital, and intestinal tracts share a common outlet. This service covers complex reconstruction using both abdominal and perineal access to separate or reconstruct the involved pathways. It is generally performed in a hospital operating room by a pediatric surgeon with expertise in congenital pelvic reconstruction. The operative report should establish the anomaly and document the use of both approaches as part of the repair.

Choose this code when the repair uses both abdominal and perineal approaches; codes 46744 and 46746 describe repairs using a single approach. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeons are paid only with 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 46748 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

46748 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$3,530.80
Alaska*Unavailable$4,869.42
ArizonaUnavailable$3,803.03
ArkansasUnavailable$3,483.44
AtlantaUnavailable$4,070.71
AustinUnavailable$3,913.08
BakersfieldUnavailable$3,817.09
Baltimore/Surr. CntysUnavailable$4,178.90
BeaumontUnavailable$3,791.02
BrazoriaUnavailable$3,795.73

46748 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
46748 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 46748 rate is calculated

Each of 46748’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 · 46748

RVUs × geographic indexes × conversion factor

Work69.63

69.63 RVUs× 1.000 GPCI

Practice expense29.17

29.17 RVUs× 1.000 GPCI

Malpractice18.65

18.65 RVUs× 1.000 GPCI

Adjusted RVUs

117.4500

Conversion factor

$33.4009

Medicare rate

$3,922.94

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

Payment rules and modifiers for 46748

46748 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46748

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 · 46748

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

46748 without 51 · national facility

$3,922.94

Cloacal repair

46748-51 · Second procedure: 50%

$1,961.47

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

46748 compared with similar codes

Compare codes · National

4 codes, side by side

  • 46748

    Cloacal repair69.63 wRVU

    Not priced

  • 46744

    Cloacal repair57.47 wRVU

    Not priced

  • 46746

    Cloacal repair63.8 wRVU

    Not priced

  • 46742

    Anorectal repair39.14 wRVU

    Not priced

How to choose

46744Cloacal repair
Use 46744 when the cloacal repair is performed through a perineal approach alone; 46748 represents a combined abdominal and perineal repair.
46746Cloacal repair
Use 46746 for cloacal repair through an abdominal approach alone. The combined abdominal and perineal approach distinguishes 46748.
46742Anorectal repair
46742 addresses repair of an imperforate anus. Use 46748 for reconstruction of a cloacal anomaly involving a shared outlet and both surgical approaches.

Codes related to 46748

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

Codes related to 46748
CodeHow it relatesNational office range
Same family
46744Cloacal repairCloacal anomaly repair using a perineal approach rather than combined approaches.No office rate
46746Cloacal repairCloacal anomaly repair using an abdominal approach rather than combined approaches.No office rate
Used instead
46742Anorectal repairFor repair of an imperforate anus when the congenital condition is not a cloacal anomaly.No office rate

46748 billing questions

When should I report 46748 instead of 46744 or 46746?

Report 46748 when the cloacal repair uses both abdominal and perineal approaches. The single-approach alternatives are 46744 and 46746.

Does the 90-day global period include routine postoperative visits?

Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.

Can modifier 50 be appended?

No. The CMS bilateral adjustment does not apply to this anatomy, so modifier 50 is inappropriate.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.

How does payment change when other procedures are performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

What documentation supports choosing this code?

Document the cloacal anomaly, the reconstruction performed, and use of both abdominal and perineal approaches.

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 46748PPRRVU2026_Oct_nonQPP.csv, line 5,623 (RVU26D)

Open CMS sourceHow we calculate rates

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