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Billing code 47146: Graft preparationMedicare rate & RVUs

A transplant surgeon reports donor-liver backbench reconstruction for each venous connection created to establish graft outflow before liver implantation.

CMS RVU26DEffective Oct 1, 2026109 payment localities171 Medicare services in 2024

Medicare pays $294.93 for 47146 nationally in a facility.

Medicare rate · 47146

Graft preparation

Swap in your local Medicare rate.

Work RVUs
5.85
Total RVUs
8.83
Global days
XXX

National rate · 2026

$294.93

Facility setting, before claim adjustments.

See every locality for 47146 → · 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 47146 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 47146 covers

A transplant surgeon reconstructs venous outflow on a donor liver graft on the back table before implantation. The work may involve joining or shaping graft veins to create a usable outflow pathway. It is distinct from removing the donor liver and implanting the graft in the recipient. This work is performed in the operating room during preparation of a graft from a deceased or living donor.

Report one unit for each venous anastomosis performed. The operative report should identify the graft, the veins joined, the number of reconstructions, and the work performed. When other procedures occur during the same session, CMS applies the standard multiple-procedure reduction: the highest-valued procedure is paid in full, and the other procedures are paid at 50%.

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 47146 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

47146 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$266.39
Alaska*Unavailable$372.32
ArizonaUnavailable$285.96
ArkansasUnavailable$262.97
AtlantaUnavailable$306.75
AustinUnavailable$292.13
BakersfieldUnavailable$282.82
Baltimore/Surr. CntysUnavailable$313.87
BeaumontUnavailable$286.96
BrazoriaUnavailable$284.60

47146 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
47146 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 47146 rate is calculated

Each of 47146’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 · 47146

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.85Practice expense 1.42Malpractice 1.56

8.8300 adjusted RVUs×$33.4009 conversion factor=$294.93

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

Payment rules and modifiers for 47146

The CMS indicators that decide how 47146 is paid alongside other services.

CMS payment indicators · 47146

Graft preparation

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

47146 without 51 · national facility

$294.93

Graft preparation

47146-51 · Second procedure: 50%

$147.47

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

47146 compared with similar codes

Compare codes

47146 vs 47143 vs 47147 vs 47135: national Medicare rates

Swap in your local Medicare rate.

  • 47146
    Graft preparation · 5.85 wRVU
    —
  • 47143
    · 0 wRVU
    —
  • 47147
    Liver graft preparation · 6.83 wRVU
    —
  • 47135
    · 87.75 wRVU
    —

How to choose

47143Prep donor liver whole
47143 covers backbench preparation of a whole donor liver graft. Use 47146 for venous anastomosis work performed on the graft.
47147Liver graft preparation
47147 identifies arterial reconstruction on the donor graft; 47146 identifies venous reconstruction.
47135Transplantation of liver
47135 covers placing the donor liver in the recipient. Code 47146 covers venous reconstruction of the graft before implantation.

Codes related to 47146

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

Codes related to 47146
CodeHow it relatesNational office range
Same family
47143Prep donor liver wholeBackbench preparation of a whole donor liver graft.No office rate
47144Prep donor liver 3-segmentBackbench preparation of a three-segment donor liver graft.No office rate
47145Prep donor liver lobe splitBackbench preparation of a lobe-split donor liver graft.No office rate
47147Liver graft preparationBackbench reconstruction of donor-liver arterial anatomy.No office rate
Often billed with
47135Transplantation of liverLiver transplantation in the recipient may occur in the same transplant encounter.No office rate

47146 billing questions

How does this differ from whole-graft preparation?

Code 47143 describes backbench preparation of a whole donor liver. Code 47146 identifies venous reconstruction work, so the record should show that this work was performed.

How many units should be reported?

Report one unit for each venous anastomosis performed. Document the number of reconstructed venous connections in the operative report.

Can this be reported with liver transplantation?

The backbench reconstruction occurs before implantation, while 47135 describes transplantation in the recipient. The operative record should support each service performed.

What documentation supports reporting this code?

Document the donor graft, the veins reconstructed, the anastomosis work, and the number of connections. A general statement that the graft was prepared does not identify the venous reconstruction.

How does the multiple-procedure payment rule affect this service?

When other procedures are performed in the same session, CMS pays the highest-valued procedure in full and pays the other procedures at 50%.

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 47146PPRRVU2026_Oct_nonQPP.csv, line 5,661 (RVU26D)

Open CMS sourceHow we calculate rates

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