No office rate
Both codes address imperforate anus with fistula anatomy. Distinguish them using the specific fistula type documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
46716 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$1196.67
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Pediatric colorectal surgery
About 46716: Imperforate anus repair with fistula
Surgical repair for imperforate anus with an anoperineal or vestibular fistula, selected according to the congenital anatomy documented by the surgeon.
This code describes operative correction of imperforate anus when the congenital anorectal opening communicates through an anoperineal or vestibular fistula. A pediatric surgeon or colorectal surgeon typically performs the reconstruction in an operating room, often as part of treatment for an anorectal malformation identified in infancy or childhood. The operative report should establish the congenital defect and the fistula’s site; an acquired fistula-in-ano is a different clinical problem.
Select the code from the documented malformation and fistula anatomy, rather than from the repair’s general complexity alone. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 46716
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.10 · 47%
- Practice expense (office) RVU14.71 · 40%
- Malpractice RVU4.57 · 13%
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.
46716 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
This code identifies the anoperineal or vestibular fistula context; 46742 is a separate imperforate-anus repair code, selected according to its documented anatomy and procedure.
No office rate
46706 describes treatment of an anorectal fistula using fibrin glue. It is not the congenital imperforate-anus repair represented here.
No office rate
46707 uses a plug to treat an anorectal fistula; this code is for congenital imperforate anus associated with an anoperineal or vestibular fistula.
The same code, a different location
How does Delaware compare?
46716 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 46716
Office
Unavailable
Facility
$1087.46
No comparable office rate is available.
Arkansas
Arkansas · 46716
Office
Unavailable
Facility
$1071.82
No comparable office rate is available.
Arizona
Arizona · 46716
Office
Unavailable
Facility
$1177.91
No comparable office rate is available.
Bakersfield
California · 46716
Office
Unavailable
Facility
$1213.46
No comparable office rate is available.
Chico
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
El Centro
California · 46716
Office
Unavailable
Facility
$1201.94
No comparable office rate is available.
Fresno
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Hanford-Corcoran
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Madera
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Merced
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Modesto
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Napa
California · 46716
Office
Unavailable
Facility
$1332.25
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 46716
Office
Unavailable
Facility
$1262.99
No comparable office rate is available.
Redding
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Rest Of California
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 46716
Office
Unavailable
Facility
$1250.13
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 46716
Office
Unavailable
Facility
$1244.95
No comparable office rate is available.
Salinas
California · 46716
Office
Unavailable
Facility
$1240.13
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 46716
Office
Unavailable
Facility
$1258.65
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 46716
Office
Unavailable
Facility
$1388.25
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 46716
Office
Unavailable
Facility
$1383.06
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 46716
Office
Unavailable
Facility
$1424.29
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 46716
Office
Unavailable
Facility
$1403.08
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 46716
Office
Unavailable
Facility
$1222.30
No comparable office rate is available.
Santa Cruz-Watsonville
California · 46716
Office
Unavailable
Facility
$1261.93
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 46716
Office
Unavailable
Facility
$1241.85
No comparable office rate is available.
Santa Rosa-Petaluma
California · 46716
Office
Unavailable
Facility
$1273.46
No comparable office rate is available.
Stockton
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Vallejo
California · 46716
Office
Unavailable
Facility
$1324.77
No comparable office rate is available.
Visalia
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Yuba City
California · 46716
Office
Unavailable
Facility
$1201.18
No comparable office rate is available.
Colorado
Colorado · 46716
Office
Unavailable
Facility
$1219.99
No comparable office rate is available.
Connecticut
Connecticut · 46716
Office
Unavailable
Facility
$1296.43
No comparable office rate is available.
Fort Lauderdale
Florida · 46716
Office
Unavailable
Facility
$1344.85
No comparable office rate is available.
Rest Of Florida
Florida · 46716
Office
Unavailable
Facility
$1270.29
No comparable office rate is available.
Atlanta
Georgia · 46716
Office
Unavailable
Facility
$1255.38
No comparable office rate is available.
Rest Of Georgia
Georgia · 46716
Office
Unavailable
Facility
$1191.37
No comparable office rate is available.
Hawaii, Guam
Hawaii · 46716
Office
Unavailable
Facility
$1218.17
No comparable office rate is available.
Iowa
Iowa · 46716
Office
Unavailable
Facility
$1081.32
No comparable office rate is available.
Idaho
Idaho · 46716
Office
Unavailable
Facility
$1095.38
No comparable office rate is available.
East St. Louis
Illinois · 46716
Office
Unavailable
Facility
$1330.60
No comparable office rate is available.
Rest Of Illinois
Illinois · 46716
Office
Unavailable
Facility
$1258.32
No comparable office rate is available.
Suburban Chicago
Illinois · 46716
Office
Unavailable
Facility
$1350.23
No comparable office rate is available.
Indiana
Indiana · 46716
Office
Unavailable
Facility
$1100.80
No comparable office rate is available.
Kansas
Kansas · 46716
Office
Unavailable
Facility
$1092.25
No comparable office rate is available.
Kentucky
Kentucky · 46716
Office
Unavailable
Facility
$1147.61
No comparable office rate is available.
New Orleans
Louisiana · 46716
Office
Unavailable
Facility
$1206.90
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 46716
Office
Unavailable
Facility
$1152.21
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 46716
Office
Unavailable
Facility
$1317.07
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 46716
Office
Unavailable
Facility
$1219.32
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 46716
Office
Unavailable
Facility
$1296.31
No comparable office rate is available.
Rest Of Maryland
Maryland · 46716
Office
Unavailable
Facility
$1214.22
No comparable office rate is available.
Rest Of Maine
Maine · 46716
Office
Unavailable
Facility
$1118.12
No comparable office rate is available.
Southern Maine
Maine · 46716
Office
Unavailable
Facility
$1154.38
No comparable office rate is available.
Detroit
Michigan · 46716
Office
Unavailable
Facility
$1302.64
No comparable office rate is available.
Rest Of Michigan
Michigan · 46716
Office
Unavailable
Facility
$1192.07
No comparable office rate is available.
Minnesota
Minnesota · 46716
Office
Unavailable
Facility
$1121.91
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 46716
Office
Unavailable
Facility
$1181.64
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 46716
Office
Unavailable
Facility
$1191.85
No comparable office rate is available.
Rest Of Missouri
Missouri · 46716
Office
Unavailable
Facility
$1143.35
No comparable office rate is available.
Mississippi
Mississippi · 46716
Office
Unavailable
Facility
$1106.99
No comparable office rate is available.
Montana**
Montana · 46716
Office
Unavailable
Facility
$1214.82
No comparable office rate is available.
North Carolina
North Carolina · 46716
Office
Unavailable
Facility
$1127.10
No comparable office rate is available.
North Dakota**
North Dakota · 46716
Office
Unavailable
Facility
$1124.46
No comparable office rate is available.
Nebraska
Nebraska · 46716
Office
Unavailable
Facility
$1082.35
No comparable office rate is available.
New Hampshire
New Hampshire · 46716
Office
Unavailable
Facility
$1216.19
No comparable office rate is available.
Northern Nj
New Jersey · 46716
Office
Unavailable
Facility
$1340.10
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 46716
Office
Unavailable
Facility
$1297.98
No comparable office rate is available.
New Mexico
New Mexico · 46716
Office
Unavailable
Facility
$1205.03
No comparable office rate is available.
Nevada**
Nevada · 46716
Office
Unavailable
Facility
$1190.12
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 46716
Office
Unavailable
Facility
$1475.35
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 46716
Office
Unavailable
Facility
$1319.56
No comparable office rate is available.
Queens
New York · 46716
Office
Unavailable
Facility
$1408.57
No comparable office rate is available.
Rest Of New York
New York · 46716
Office
Unavailable
Facility
$1145.22
No comparable office rate is available.
Ohio
Ohio · 46716
Office
Unavailable
Facility
$1173.60
No comparable office rate is available.
Oklahoma
Oklahoma · 46716
Office
Unavailable
Facility
$1128.51
No comparable office rate is available.
Portland
Oregon · 46716
Office
Unavailable
Facility
$1239.72
No comparable office rate is available.
Rest Of Oregon
Oregon · 46716
Office
Unavailable
Facility
$1167.82
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 46716
Office
Unavailable
Facility
$1275.01
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 46716
Office
Unavailable
Facility
$1166.44
No comparable office rate is available.
Puerto Rico
Puerto Rico · 46716
Office
Unavailable
Facility
$1218.24
No comparable office rate is available.
Rhode Island
Rhode Island · 46716
Office
Unavailable
Facility
$1225.71
No comparable office rate is available.
South Carolina
South Carolina · 46716
Office
Unavailable
Facility
$1154.89
No comparable office rate is available.
South Dakota**
South Dakota · 46716
Office
Unavailable
Facility
$1113.77
No comparable office rate is available.
Tennessee
Tennessee · 46716
Office
Unavailable
Facility
$1099.74
No comparable office rate is available.
Austin
Texas · 46716
Office
Unavailable
Facility
$1227.36
No comparable office rate is available.
Beaumont
Texas · 46716
Office
Unavailable
Facility
$1160.07
No comparable office rate is available.
Brazoria
Texas · 46716
Office
Unavailable
Facility
$1181.69
No comparable office rate is available.
Dallas
Texas · 46716
Office
Unavailable
Facility
$1196.62
No comparable office rate is available.
Fort Worth
Texas · 46716
Office
Unavailable
Facility
$1193.70
No comparable office rate is available.
Galveston
Texas · 46716
Office
Unavailable
Facility
$1190.00
No comparable office rate is available.
Houston
Texas · 46716
Office
Unavailable
Facility
$1273.65
No comparable office rate is available.
Rest Of Texas
Texas · 46716
Office
Unavailable
Facility
$1175.26
No comparable office rate is available.
Utah
Utah · 46716
Office
Unavailable
Facility
$1170.08
No comparable office rate is available.
Virginia
Virginia · 46716
Office
Unavailable
Facility
$1161.90
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 46716
Office
Unavailable
Facility
$1218.24
No comparable office rate is available.
Vermont
Vermont · 46716
Office
Unavailable
Facility
$1134.81
No comparable office rate is available.
Rest Of Washington
Washington · 46716
Office
Unavailable
Facility
$1212.11
No comparable office rate is available.
Seattle (King Cnty)
Washington · 46716
Office
Unavailable
Facility
$1327.28
No comparable office rate is available.
Wisconsin
Wisconsin · 46716
Office
Unavailable
Facility
$1088.86
No comparable office rate is available.
West Virginia
West Virginia · 46716
Office
Unavailable
Facility
$1216.55
No comparable office rate is available.
Wyoming**
Wyoming · 46716
Office
Unavailable
Facility
$1175.44
No comparable office rate is available.
See how rates vary across the country
46716 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 46716 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1316.34
$1196.67 × 110% = $1316.34
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 46716 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,616
- Code
- 46716
- Physician work
- 17.10
- Practice expense
- 14.71
- Malpractice
- 4.57
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.10 | × 1.005 | 17.1855 |
| Practice expense | 14.71 | × 0.988 | 14.5335 |
| Malpractice | 4.57 | × 0.899 | 4.1084 |
| Total RVUs | 35.8274 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$1196.67
Open 46716 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.1 | 1.005 |
| Practice expense | 14.71 | 0.988 |
| Malpractice | 4.57 | 0.899 |
(17.1 × 1.005 + 14.71 × 0.988 + 4.57 × 0.899) × $33.4009 = $1196.67
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
46716 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1196.67 | RVU26D |
| 2026-07-01 | Not available in this setting | $1196.67 | RVU26C |
| 2026-04-01 | Not available in this setting | $1196.67 | RVU26B |
| 2026-01-01 | Not available in this setting | $1196.67 | RVU26A |
| 2025-10-01 | Not available in this setting | $1210.55 | RVU25D |
| 2025-07-01 | Not available in this setting | $1210.55 | RVU25C |
| 2025-04-01 | Not available in this setting | $1210.55 | RVU25B |
| 2025-01-01 | Not available in this setting | $1210.55 | RVU25A |
46716 billing questions
How is this different from code 46715?
Both concern congenital imperforate anus with fistula anatomy. Use the documented fistula type to distinguish the anoperineal category from the anoperineal or vestibular category represented by this code.
Is this for an acquired fistula-in-ano?
No. This code is for repair of imperforate anus associated with a congenital anoperineal or vestibular fistula, not a typical acquired anal fistula.
Can a separate fistula procedure be reported at the same session?
Report another procedure only when the surgeon documents a distinct service beyond the repair represented by this code. When multiple procedures are performed in the same session, CMS applies the standard multiple procedure reduction.
Should modifier 50 be used for a bilateral repair?
No. Modifier 50 is inappropriate for this code’s descriptor and anatomy.
What documentation supports code selection?
The operative report should identify imperforate anus and describe the fistula’s site and the repair performed. Those anatomic details distinguish this service from other congenital anorectal repairs.
How are assistant and co-surgeon services treated?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,61346710,,Repr per/vag pouch sngl proc,A,,16.71,10.80,NA,10.80,,4.46,31.97,31.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61446712,,Repr per/vag pouch dbl proc,A,,35.54,17.12,NA,17.12,,9.52,62.18,62.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61546715,,Rep perf anoper fistu,A,,7.43,7.18,NA,7.18,,1.98,16.59,16.59,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61646716,,Rep perf anoper/vestib fistu,A,,17.10,14.71,NA,14.71,,4.57,36.38,36.38,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61746730,,Construction of absent anus,A,,29.88,19.23,NA,19.23,,8.00,57.11,57.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61846735,,Construction of absent anus,A,,35.24,20.52,NA,20.52,,9.42,65.18,65.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61946740,,Construction of absent anus,A,,33.05,20.14,NA,20.14,,8.85,62.04,62.04,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503