No office rate
Choose 46750 for a primary perineal repair. Choose 46751 when the operative service is a secondary perineal reconstruction.
On this page
CMS RVU26D · Effective 2026-10-01
46751 in Visalia
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$658.56
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.
Colorectal surgery
About 46751: Secondary perineal anal sphincter repair
Reports secondary perineal reconstruction of a disrupted anal sphincter, such as repair of a chronic defect associated with fecal incontinence.
This code describes a secondary repair of the anal sphincter through a perineal approach, typically to reconstruct a sphincter disrupted by an earlier injury or operation. A colorectal surgeon or another surgeon experienced in pelvic floor reconstruction may perform it for a chronic defect associated with impaired continence. The operative note should establish the sphincter defect and describe the secondary reconstruction and perineal approach.
Report the code for the secondary repair, not a primary repair or an operation using a different approach. The service has a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Do not report modifier 50 for this repair.
CMS billing rules for 46751
- 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 RVU9.07 · 46%
- Practice expense (office) RVU8.39 · 42%
- Malpractice RVU2.42 · 12%
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.
46751 compared with similar codes
Office rates for Visalia, from the same CMS release.
No office rate
46760 represents anal sphincter repair by a transabdominal approach. This code is for secondary repair through a perineal approach.
No office rate
46700 addresses repair of an anal stricture, not reconstruction of a disrupted anal sphincter.
No office rate
46753 describes reconstruction of the anus. Use 46751 when the documented procedure is secondary repair of the anal sphincter through a perineal approach.
The same code, a different location
How does Visalia compare?
46751 across payment areas
Same release and payment basis · bars start at $0
Visalia · This locality
Unavailable
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.
No comparable rate is available in this setting.
Other payment areas listed in California 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
Madera
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Merced
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Modesto
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Napa
California · 46751
Office
Unavailable
Facility
$732.44
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 46751
Office
Unavailable
Facility
$693.02
No comparable office rate is available.
Redding
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Rest Of California
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 46751
Office
Unavailable
Facility
$684.48
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 46751
Office
Unavailable
Facility
$683.09
No comparable office rate is available.
Salinas
California · 46751
Office
Unavailable
Facility
$680.45
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 46751
Office
Unavailable
Facility
$691.00
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 46751
Office
Unavailable
Facility
$763.96
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 46751
Office
Unavailable
Facility
$761.21
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 46751
Office
Unavailable
Facility
$783.69
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 46751
Office
Unavailable
Facility
$772.46
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 46751
Office
Unavailable
Facility
$670.61
No comparable office rate is available.
Santa Cruz-Watsonville
California · 46751
Office
Unavailable
Facility
$693.12
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 46751
Office
Unavailable
Facility
$681.51
No comparable office rate is available.
Santa Rosa-Petaluma
California · 46751
Office
Unavailable
Facility
$699.49
No comparable office rate is available.
Stockton
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Vallejo
California · 46751
Office
Unavailable
Facility
$728.48
No comparable office rate is available.
Yuba City
California · 46751
Office
Unavailable
Facility
$658.56
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 46751
Office
Unavailable
Facility
$739.38
No comparable office rate is available.
Miami
Florida · 46751
Office
Unavailable
Facility
$799.09
No comparable office rate is available.
Chicago
Illinois · 46751
Office
Unavailable
Facility
$772.21
No comparable office rate is available.
Manhattan
New York · 46751
Office
Unavailable
Facility
$776.16
No comparable office rate is available.
Alaska*
Alaska · 46751
Office
Unavailable
Facility
$797.41
No comparable office rate is available.
Alabama
Alabama · 46751
Office
Unavailable
Facility
$593.90
No comparable office rate is available.
Arkansas
Arkansas · 46751
Office
Unavailable
Facility
$585.29
No comparable office rate is available.
Arizona
Arizona · 46751
Office
Unavailable
Facility
$643.68
No comparable office rate is available.
Colorado
Colorado · 46751
Office
Unavailable
Facility
$667.88
No comparable office rate is available.
Connecticut
Connecticut · 46751
Office
Unavailable
Facility
$708.62
No comparable office rate is available.
Delaware
Delaware · 46751
Office
Unavailable
Facility
$654.00
No comparable office rate is available.
Fort Lauderdale
Florida · 46751
Office
Unavailable
Facility
$732.96
No comparable office rate is available.
Rest Of Florida
Florida · 46751
Office
Unavailable
Facility
$692.34
No comparable office rate is available.
Atlanta
Georgia · 46751
Office
Unavailable
Facility
$685.65
No comparable office rate is available.
Rest Of Georgia
Georgia · 46751
Office
Unavailable
Facility
$649.26
No comparable office rate is available.
Hawaii, Guam
Hawaii · 46751
Office
Unavailable
Facility
$668.37
No comparable office rate is available.
Iowa
Iowa · 46751
Office
Unavailable
Facility
$591.45
No comparable office rate is available.
Idaho
Idaho · 46751
Office
Unavailable
Facility
$598.99
No comparable office rate is available.
East St. Louis
Illinois · 46751
Office
Unavailable
Facility
$723.55
No comparable office rate is available.
Rest Of Illinois
Illinois · 46751
Office
Unavailable
Facility
$685.14
No comparable office rate is available.
Suburban Chicago
Illinois · 46751
Office
Unavailable
Facility
$736.10
No comparable office rate is available.
Indiana
Indiana · 46751
Office
Unavailable
Facility
$602.01
No comparable office rate is available.
Kansas
Kansas · 46751
Office
Unavailable
Facility
$597.02
No comparable office rate is available.
Kentucky
Kentucky · 46751
Office
Unavailable
Facility
$626.03
No comparable office rate is available.
New Orleans
Louisiana · 46751
Office
Unavailable
Facility
$658.47
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 46751
Office
Unavailable
Facility
$628.39
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 46751
Office
Unavailable
Facility
$721.90
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 46751
Office
Unavailable
Facility
$667.30
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 46751
Office
Unavailable
Facility
$708.47
No comparable office rate is available.
Rest Of Maryland
Maryland · 46751
Office
Unavailable
Facility
$663.77
No comparable office rate is available.
Rest Of Maine
Maine · 46751
Office
Unavailable
Facility
$611.04
No comparable office rate is available.
Southern Maine
Maine · 46751
Office
Unavailable
Facility
$631.66
No comparable office rate is available.
Detroit
Michigan · 46751
Office
Unavailable
Facility
$709.65
No comparable office rate is available.
Rest Of Michigan
Michigan · 46751
Office
Unavailable
Facility
$650.06
No comparable office rate is available.
Minnesota
Minnesota · 46751
Office
Unavailable
Facility
$615.23
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 46751
Office
Unavailable
Facility
$645.06
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 46751
Office
Unavailable
Facility
$650.72
No comparable office rate is available.
Rest Of Missouri
Missouri · 46751
Office
Unavailable
Facility
$623.24
No comparable office rate is available.
Mississippi
Mississippi · 46751
Office
Unavailable
Facility
$603.96
No comparable office rate is available.
Montana**
Montana · 46751
Office
Unavailable
Facility
$663.85
No comparable office rate is available.
North Carolina
North Carolina · 46751
Office
Unavailable
Facility
$616.05
No comparable office rate is available.
North Dakota**
North Dakota · 46751
Office
Unavailable
Facility
$616.00
No comparable office rate is available.
Nebraska
Nebraska · 46751
Office
Unavailable
Facility
$592.16
No comparable office rate is available.
New Hampshire
New Hampshire · 46751
Office
Unavailable
Facility
$665.40
No comparable office rate is available.
Northern Nj
New Jersey · 46751
Office
Unavailable
Facility
$733.43
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 46751
Office
Unavailable
Facility
$709.75
No comparable office rate is available.
New Mexico
New Mexico · 46751
Office
Unavailable
Facility
$657.00
No comparable office rate is available.
Nevada**
Nevada · 46751
Office
Unavailable
Facility
$650.79
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 46751
Office
Unavailable
Facility
$805.63
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 46751
Office
Unavailable
Facility
$721.24
No comparable office rate is available.
Queens
New York · 46751
Office
Unavailable
Facility
$770.13
No comparable office rate is available.
Rest Of New York
New York · 46751
Office
Unavailable
Facility
$625.99
No comparable office rate is available.
Ohio
Ohio · 46751
Office
Unavailable
Facility
$640.28
No comparable office rate is available.
Oklahoma
Oklahoma · 46751
Office
Unavailable
Facility
$616.00
No comparable office rate is available.
Portland
Oregon · 46751
Office
Unavailable
Facility
$679.27
No comparable office rate is available.
Rest Of Oregon
Oregon · 46751
Office
Unavailable
Facility
$638.88
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 46751
Office
Unavailable
Facility
$696.55
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 46751
Office
Unavailable
Facility
$636.59
No comparable office rate is available.
Puerto Rico
Puerto Rico · 46751
Office
Unavailable
Facility
$665.88
No comparable office rate is available.
Rhode Island
Rhode Island · 46751
Office
Unavailable
Facility
$670.28
No comparable office rate is available.
South Carolina
South Carolina · 46751
Office
Unavailable
Facility
$630.59
No comparable office rate is available.
South Dakota**
South Dakota · 46751
Office
Unavailable
Facility
$610.34
No comparable office rate is available.
Tennessee
Tennessee · 46751
Office
Unavailable
Facility
$601.08
No comparable office rate is available.
Austin
Texas · 46751
Office
Unavailable
Facility
$671.65
No comparable office rate is available.
Beaumont
Texas · 46751
Office
Unavailable
Facility
$633.05
No comparable office rate is available.
Brazoria
Texas · 46751
Office
Unavailable
Facility
$646.13
No comparable office rate is available.
Dallas
Texas · 46751
Office
Unavailable
Facility
$654.14
No comparable office rate is available.
Fort Worth
Texas · 46751
Office
Unavailable
Facility
$652.39
No comparable office rate is available.
Galveston
Texas · 46751
Office
Unavailable
Facility
$650.57
No comparable office rate is available.
Houston
Texas · 46751
Office
Unavailable
Facility
$694.86
No comparable office rate is available.
Rest Of Texas
Texas · 46751
Office
Unavailable
Facility
$641.88
No comparable office rate is available.
Utah
Utah · 46751
Office
Unavailable
Facility
$638.95
No comparable office rate is available.
Virginia
Virginia · 46751
Office
Unavailable
Facility
$635.48
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 46751
Office
Unavailable
Facility
$665.88
No comparable office rate is available.
Vermont
Vermont · 46751
Office
Unavailable
Facility
$621.28
No comparable office rate is available.
Rest Of Washington
Washington · 46751
Office
Unavailable
Facility
$663.48
No comparable office rate is available.
Seattle (King Cnty)
Washington · 46751
Office
Unavailable
Facility
$727.98
No comparable office rate is available.
Wisconsin
Wisconsin · 46751
Office
Unavailable
Facility
$596.31
No comparable office rate is available.
West Virginia
West Virginia · 46751
Office
Unavailable
Facility
$662.14
No comparable office rate is available.
Wyoming**
Wyoming · 46751
Office
Unavailable
Facility
$642.99
No comparable office rate is available.
See how rates vary across the country
46751 · 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?
Visalia is a Medicare payment area. Our Census mapping connects it to 70 cities and communities in California, 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 46751 in Visalia. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$724.42
$658.56 × 110% = $724.42
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 46751 in Visalia.
PPRRVU2026_Oct_nonQPP.csv
5,625
- Code
- 46751
- Physician work
- 9.07
- Practice expense
- 8.39
- Malpractice
- 2.42
GPCI2026.csv
34
- Locality
- Visalia
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.07 | × 1.017 | 9.2242 |
| Practice expense | 8.39 | × 1.096 | 9.1954 |
| Malpractice | 2.42 | × 0.536 | 1.2971 |
| Total RVUs | 19.7168 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Visalia$658.56
Open 46751 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.07 | 1.017 |
| Practice expense | 8.39 | 1.096 |
| Malpractice | 2.42 | 0.536 |
(9.07 × 1.017 + 8.39 × 1.096 + 2.42 × 0.536) × $33.4009 = $658.56
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
46751 · 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 | $658.56 | RVU26D |
| 2026-07-01 | Not available in this setting | $658.56 | RVU26C |
| 2026-04-01 | Not available in this setting | $658.56 | RVU26B |
| 2026-01-01 | Not available in this setting | $658.56 | RVU26A |
| 2025-10-01 | Not available in this setting | $656.96 | RVU25D |
| 2025-07-01 | Not available in this setting | $656.96 | RVU25C |
| 2025-04-01 | Not available in this setting | $656.96 | RVU25B |
| 2025-01-01 | Not available in this setting | $656.96 | RVU25A |
46751 billing questions
How does this differ from 46750?
46751 is for a secondary perineal repair, such as reconstruction of an established defect. 46750 describes a primary perineal repair.
When should a different approach code be considered?
Use the code that matches the operative approach and service performed. A transabdominal anal sphincter repair is represented by a different code in this family, not 46751.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included. The period also includes the preoperative visit on the day before surgery.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be appended?
No. This repair is not reported as a bilateral procedure, and modifier 50 is inappropriate.
What documentation supports 46751?
Document the established sphincter defect, why secondary reconstruction was performed, and the perineal approach. The operative report should distinguish the repair from a primary repair or transabdominal procedure.
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.
5,62246746,,Repair of cloacal anomaly,A,,63.80,27.76,NA,27.76,,17.08,108.64,108.64,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62346748,,Repair of cloacal anomaly,A,,69.63,29.17,NA,29.17,,18.65,117.45,117.45,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62446750,,Repair of anal sphincter,A,,11.85,6.66,NA,6.66,,2.06,20.57,20.57,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62546751,,Repair of anal sphincter,A,,9.07,8.39,NA,8.39,,2.42,19.88,19.88,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62646753,,Reconstruction of anus,A,,8.67,7.40,NA,7.40,,2.33,18.40,18.40,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62746754,,Removal of suture from anus,A,,2.93,8.07,,3.83,,0.42,11.42,7.18,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62846760,,Repair of anal sphincter,A,,17.01,11.93,NA,11.93,,2.46,31.40,31.40,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3101112,CA,67,SANTA ROSA-PETALUMA,1.030,1.228,0.536
3201112,CA,68,STOCKTON,1.017,1.096,0.536
3301112,CA,53,VALLEJO,1.063,1.318,0.459
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781