$251.95
46020 reports placement of a seton; 46030 reports removal of an anal seton. Use the code matching the work performed during the encounter.
On this page
CMS RVU26D · Effective 2026-10-01
46020 Seton placement Medicare reimbursement rates in Alabama
Reports placement of a loop through an anal fistula tract to maintain drainage, often as part of staged management of complex fistula disease. Compare 46020 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 46020 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$100.87
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Colorectal surgery
About 46020: Anal fistula seton placement
Reports placement of a loop through an anal fistula tract to maintain drainage, often as part of staged management of complex fistula disease.
A surgeon passes a loop through an anal fistula tract and secures it so the tract remains open for drainage. Colorectal and general surgeons commonly perform this procedure for fistulas managed in stages, including situations where immediate division of the tract is not the treatment plan. It is performed in an operating room or other procedural setting, depending on the patient and clinical circumstances.
Report 46020 for placing the seton, not for removing one or draining an abscess alone. The operative note should identify the fistula tract and document the seton placement. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery reporting are not permitted.
CMS billing rules for 46020
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.81 · 55%
- Practice expense (office) RVU1.15 · 35%
- Malpractice RVU0.36 · 11%
1.4K
Medicare services in 2024 · #2740 by national volume
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.
46020 compared with similar codes
Office rates for Alabama, from the same CMS release.
$560.98
46040 describes incision and drainage of an ischiorectal or perirectal abscess. It is not a substitute for documenting placement of a seton through a fistula tract.
$534.72
46270 applies when a superficial anal fistula is treated by opening the tract. Choose 46020 when the documented service is seton placement.
Compare 46020 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$100.87
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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 46020 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,570
- Code
- 46020
- Physician work
- 1.81
- Practice expense
- 1.15
- Malpractice
- 0.36
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.81 | × 1.000 | 1.8100 |
| Practice expense | 1.15 | × 0.875 | 1.0062 |
| Malpractice | 0.36 | × 0.566 | 0.2038 |
| Total RVUs | 3.0200 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$100.87
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.81 | 1 |
| Practice expense | 1.15 | 0.875 |
| Malpractice | 0.36 | 0.566 |
(1.81 × 1 + 1.15 × 0.875 + 0.36 × 0.566) × $33.4009 = $100.87
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.
46020 billing questions
How does seton placement differ from fistulotomy?
46020 reports placement of a loop to keep the fistula tract draining. A fistulotomy code describes opening the tract as the operative treatment, rather than placing a seton.
Can an abscess drainage code also be reported?
A separate abscess drainage service may be relevant when an abscess is also treated, but the documentation should support that distinct work. Seton placement alone does not describe abscess drainage.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is subject to a statutory restriction. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid 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 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.
5,56745915,,Remove rectal obstruction,A,,3.11,8.35,,3.21,,0.62,12.08,6.94,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56845990,,Surg dx exam anorectal,A,,1.76,0.87,NA,0.87,,0.35,2.98,2.98,0,000,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,56945999,,Unlisted procedure rectum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57046020,,Placement of seton,A,,1.81,1.15,NA,1.15,,0.36,3.32,3.32,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57146030,,Removal anal seton oth mrk,A,,1.44,6.82,,0.73,,0.24,8.50,2.41,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57246040,,I&d ischiorct&/perirct absc,A,,5.24,12.43,,6.58,,1.20,18.87,13.02,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57346045,,I&d absc tranal under anes,A,,5.72,6.43,NA,6.43,,1.25,13.40,13.40,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515