Billing code 46940: Anal fissure treatmentMedicare rate & RVUs
Reports procedural treatment of an anal fissure with anal sphincter dilation when the fissure is managed without fissurectomy.
Medicare pays $290.25 for 46940 nationally in the office and $136.61 in a hospital or facility. Local office rates run $256.09–$382.56.
Medicare rate · 46940
Anal fissure treatment
Swap in your local Medicare rate.
- Work RVUs
- 2.29
- Total RVUs
- 8.69
- Global days
- 010
National rate · 2026
$290.25
Office setting, before claim adjustments.
See every locality for 46940 → · 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
What 46940 covers
This code describes procedural management of an anal fissure that includes dilation of the anal sphincter, such as manual or balloon dilation, without fissurectomy. A surgeon, commonly a colorectal or general surgeon, may perform the treatment for a symptomatic fissure in an outpatient or facility setting. The record should identify the fissure and describe the treatment performed, including the dilation method and whether fissure tissue was excised.
Report 46940 when the documented service meets this treatment approach; use the related fissure code when fissurectomy is performed. The service has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed 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. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 46940 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$256.09 to $382.56
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $259.92 | $125.48 |
| Alaska* | $336.38 | $172.75 |
| Arizona | $282.31 | $133.42 |
| Arkansas | $256.09 | $124.11 |
| Atlanta | $296.07 | $139.96 |
| Austin | $300.79 | $138.24 |
| Bakersfield | $306.54 | $138.14 |
| Baltimore/Surr. Cntys | $309.00 | $144.14 |
| Beaumont | $271.24 | $131.42 |
| Brazoria | $286.48 | $134.21 |
| Chicago | $306.94 | $152.53 |
| Chico | $305.53 | $137.14 |
| Colorado | $301.54 | $138.07 |
| Connecticut | $309.80 | $144.32 |
| Dallas | $288.47 | $135.44 |
| Dc + Md/Va Suburbs | $331.67 | $150.68 |
| Delaware | $287.03 | $135.23 |
| Detroit | $291.20 | $142.93 |
| East St. Louis | $285.94 | $144.59 |
| El Centro | $305.59 | $137.19 |
| Fort Lauderdale | $302.33 | $146.69 |
| Fort Worth | $286.61 | $135.11 |
| Fresno | $305.53 | $137.14 |
| Galveston | $287.44 | $134.87 |
| Hanford-Corcoran | $305.53 | $137.14 |
| Hawaii, Guam | $313.02 | $138.32 |
| Houston | $293.85 | $141.28 |
| Idaho | $267.93 | $126.57 |
| Indiana | $269.49 | $127.07 |
| Iowa | $266.03 | $125.44 |
| Kansas | $265.06 | $126.16 |
| Kentucky | $266.83 | $130.24 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $326.44 | $144.68 |
| Madera | $305.53 | $137.14 |
| Manhattan | $334.74 | $156.20 |
| Merced | $305.53 | $137.14 |
| Metropolitan Boston | $331.31 | $147.86 |
| Metropolitan Kansas City | $277.66 | $133.39 |
| Metropolitan Philadelphia | $302.17 | $142.23 |
| Metropolitan St. Louis | $280.58 | $134.31 |
| Miami | $316.41 | $156.47 |
| Minnesota | $287.88 | $129.78 |
| Mississippi | $259.11 | $126.83 |
| Modesto | $305.53 | $137.14 |
| Montana** | $290.23 | $136.59 |
| Napa | $353.58 | $151.08 |
| Nebraska | $267.42 | $125.61 |
| Nevada** | $288.50 | $134.71 |
| New Hampshire | $297.08 | $137.13 |
| New Mexico | $275.83 | $134.94 |
| New Orleans | $279.92 | $135.34 |
| North Carolina | $272.49 | $129.14 |
| North Dakota** | $283.31 | $129.67 |
| Northern Nj | $328.20 | $149.97 |
| Nyc Suburbs/Long Island | $343.36 | $160.68 |
| Ohio | $272.77 | $132.49 |
| Oklahoma | $266.02 | $128.82 |
| Oxnard-Thousand Oaks-Ventura | $324.77 | $143.16 |
| Portland | $310.92 | $140.22 |
| Poughkpsie/N Nyc Suburbs | $315.35 | $147.11 |
| Puerto Rico | $292.30 | $136.97 |
| Queens | $337.09 | $155.49 |
| Redding | $305.53 | $137.14 |
| Rest Of California | $305.53 | $137.14 |
| Rest Of Florida | $287.24 | $140.36 |
| Rest Of Georgia | $270.67 | $133.62 |
| Rest Of Illinois | $279.25 | $138.98 |
| Rest Of Louisiana | $266.52 | $130.55 |
| Rest Of Maine | $269.67 | $128.32 |
| Rest Of Maryland | $292.49 | $137.00 |
| Rest Of Massachusetts | $299.81 | $138.03 |
| Rest Of Michigan | $274.18 | $133.90 |
| Rest Of Missouri | $262.06 | $129.62 |
| Rest Of New Jersey | $313.04 | $145.26 |
| Rest Of New York | $276.68 | $130.72 |
| Rest Of Oregon | $285.97 | $132.94 |
| Rest Of Pennsylvania | $273.04 | $132.00 |
| Rest Of Texas | $278.81 | $133.01 |
| Rest Of Washington | $299.16 | $137.38 |
| Rhode Island | $297.11 | $138.40 |
| Riverside-San Bernardino-Ontario | $309.31 | $140.92 |
| Sacramento-Roseville-Folsom | $320.52 | $141.83 |
| Salinas | $319.33 | $141.26 |
| San Diego-Chula Vista-Carlsbad | $326.80 | $143.04 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $374.05 | $157.41 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $373.65 | $157.01 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $382.56 | $161.01 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $380.94 | $159.38 |
| San Luis Obispo-Paso Robles | $314.22 | $139.22 |
| Santa Cruz-Watsonville | $329.88 | $143.20 |
| Santa Maria-Santa Barbara | $320.52 | $141.37 |
| Santa Rosa-Petaluma | $333.20 | $144.52 |
| Seattle (King Cnty) | $337.81 | $149.29 |
| South Carolina | $273.14 | $131.18 |
| South Dakota** | $282.49 | $128.85 |
| Southern Maine | $284.12 | $131.86 |
| Stockton | $305.53 | $137.14 |
| Suburban Chicago | $305.27 | $147.48 |
| Tennessee | $266.45 | $126.79 |
| Utah | $276.94 | $132.51 |
| Vallejo | $353.01 | $150.51 |
| Vermont | $282.46 | $130.35 |
| Virgin Islands | $292.30 | $136.97 |
| Virginia | $283.38 | $132.35 |
| Visalia | $305.53 | $137.14 |
| West Virginia | $268.82 | $135.30 |
| Wisconsin | $273.68 | $126.49 |
| Wyoming** | $287.21 | $133.57 |
| Yuba City | $305.53 | $137.14 |
46940 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$256.09
$344.04
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $336.38 | 1 |
| AL | $259.92 | 1 |
| AR | $256.09 | 1 |
| AZ | $282.31 | 1 |
| CA | $305.53–$382.56 | 29 |
| CO | $301.54 | 1 |
| CT | $309.80 | 1 |
| DC | $331.67 | 1 |
| DE | $287.03 | 1 |
| FL | $287.24–$316.41 | 3 |
| GA | $270.67–$296.07 | 2 |
| GU | $313.02 | 1 |
| HI | $313.02 | 1 |
| IA | $266.03 | 1 |
| ID | $267.93 | 1 |
| IL | $279.25–$306.94 | 4 |
| IN | $269.49 | 1 |
| KS | $265.06 | 1 |
| KY | $266.83 | 1 |
| LA | $266.52–$279.92 | 2 |
| MA | $299.81–$331.31 | 2 |
| MD | $292.49–$331.67 | 3 |
| ME | $269.67–$284.12 | 2 |
| MI | $274.18–$291.20 | 2 |
| MN | $287.88 | 1 |
| MO | $262.06–$280.58 | 3 |
| MS | $259.11 | 1 |
| MT | $290.23 | 1 |
| NC | $272.49 | 1 |
| ND | $283.31 | 1 |
| NE | $267.42 | 1 |
| NH | $297.08 | 1 |
| NJ | $313.04–$328.20 | 2 |
| NM | $275.83 | 1 |
| NV | $288.50 | 1 |
| NY | $276.68–$343.36 | 5 |
| OH | $272.77 | 1 |
| OK | $266.02 | 1 |
| OR | $285.97–$310.92 | 2 |
| PA | $273.04–$302.17 | 2 |
| PR | $292.30 | 1 |
| RI | $297.11 | 1 |
| SC | $273.14 | 1 |
| SD | $282.49 | 1 |
| TN | $266.45 | 1 |
| TX | $271.24–$300.79 | 8 |
| UT | $276.94 | 1 |
| VA | $283.38–$331.67 | 2 |
| VI | $292.30 | 1 |
| VT | $282.46 | 1 |
| WA | $299.16–$337.81 | 2 |
| WI | $273.68 | 1 |
| WV | $268.82 | 1 |
| WY | $287.21 | 1 |
How the 46940 rate is calculated
Each of 46940’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 · 46940
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.29Practice expense 6.05Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46940
46940 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46940
Anal fissure treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46940
Anal fissure treatment
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46940 without 51 · national office
$290.25
Anal fissure treatment
46940-51 · Second procedure: 50%
$145.13
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%).
46940 compared with similar codes
Compare codes
46940 vs 46942 vs 46080 vs 46200 vs 46930: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46942Anal fissure treatment
- Both address anal fissure treatment with sphincter dilation. Choose 46940 when fissurectomy is not performed; 46942 applies when fissurectomy is included.
- 46080Anal sphincterotomy
- 46080 describes incision of the anal sphincter. Use 46940 for fissure treatment involving dilation rather than sphincter incision.
- 46200Fissure surgery
- 46200 is the fissurectomy approach. 46940 is distinguished by sphincter dilation without fissurectomy.
- 46930Hemorrhoid treatment
- 46930 treats internal hemorrhoids, not an anal fissure. Select by the condition treated and the documented procedure.
46940 billing questions
How does 46940 differ from 46942?
46940 is for fissure treatment with sphincter dilation without fissurectomy. Use 46942 when the treatment includes fissurectomy.
What documentation supports 46940?
Document the anal fissure, the treatment performed, and the sphincter dilation method. Note whether fissure tissue was excised.
Are postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in 46940.
Can modifier 50 be used?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery billing are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
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