No office rate
Use 46700 for adult anal stricture repair and 46705 for the infant counterpart. The patient category is the key distinction.
On this page
CMS RVU26D · Effective 2026-10-01
46700 Anal repair Medicare reimbursement rates in California
Surgical enlargement of a narrowed adult anal canal is reported for repair of a fixed stricture, including post-traumatic narrowing. Compare 46700 office and facility rates across CMS payment localities in California.
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 46700 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$646.07–$768.22
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $122.15 per service.
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.
Where 46700 pays more and less in California
Colorectal surgery
About 46700: Adult anal narrowing repair
Surgical enlargement of a narrowed adult anal canal is reported for repair of a fixed stricture, including post-traumatic narrowing.
This procedure surgically enlarges a narrowed anal canal through anoplasty. It is used for an adult with a fixed anal stricture that impairs passage of stool; post-traumatic narrowing is a typical example. A colorectal or general surgeon usually performs the repair in an operating room, with the operative approach guided by the location and extent of the scarred canal.
Report this code for the adult stricture repair, not for an infant repair or an operation directed at an anal sphincter defect. The operative report should establish the anal narrowing, its clinical effect, the repair performed, and the patient’s age. CMS assigns a 90-day global period, including 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 the others at 50%. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 46700
- 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
- 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 RVU9.56 · 50%
- Practice expense (office) RVU8.00 · 42%
- Malpractice RVU1.59 · 8%
145
Medicare services in 2024 · #4587 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.
46700 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
46700 addresses a narrowed anal canal. Consider 46750 when the operation repairs the anal sphincter rather than enlarging a stricture.
No office rate
46700 is selected for fixed anal canal narrowing; 46760 describes a different operative target, anal sphincter repair.
Compare 46700 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $650.58 |
| Chico | Office Unavailable | Facility $646.07 |
| El Centro | Office Unavailable | Facility $646.33 |
| Fresno | Office Unavailable | Facility $646.07 |
| Hanford-Corcoran | Office Unavailable | Facility $646.07 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $683.77 |
| Madera | Office Unavailable | Facility $646.07 |
| Merced | Office Unavailable | Facility $646.07 |
| Modesto | Office Unavailable | Facility $646.07 |
| Napa | Office Unavailable | Facility $718.59 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $677.18 |
| Redding | Office Unavailable | Facility $646.07 |
| Rest Of California | Office Unavailable | Facility $646.07 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $663.22 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $670.04 |
| Salinas | Office Unavailable | Facility $667.37 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $677.26 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $750.79 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $748.98 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $768.22 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $760.83 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $657.56 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $679.14 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $668.28 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $685.49 |
| Stockton | Office Unavailable | Facility $646.07 |
| Vallejo | Office Unavailable | Facility $715.98 |
| Visalia | Office Unavailable | Facility $646.07 |
| Yuba City | Office Unavailable | Facility $646.07 |
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46700 billing questions
How do I distinguish this code from 46705?
This code is for adult anal stricture repair; 46705 is the related code for an infant. Confirm the patient category and the operative indication in the record.
Can modifier 50 be reported for repair on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code because the descriptor or anatomy does not support modifier 50.
Are related postoperative visits separately reported during the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
How is this code affected when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
What documentation supports reporting this repair?
Document the adult patient’s fixed anal narrowing, its effect on function, and the surgical repair performed. The record should distinguish canal stenosis from a sphincter defect.
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.
5,60646612,,Anoscopy remove lesions,A,,1.46,9.13,,0.86,,0.39,10.98,2.71,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60746614,,Anoscopy control bleeding,A,,0.98,4.35,,0.70,,0.16,5.49,1.84,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60846615,,Anoscopy,A,,1.46,4.07,,0.84,,0.21,5.74,2.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60946700,,Repair of anal stricture,A,,9.56,8.00,NA,8.00,,1.59,19.15,19.15,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61046705,,Repair of anal stricture,A,,7.24,8.09,NA,8.09,,1.93,17.26,17.26,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61146706,,Repr of anal fistula w/glue,A,,2.38,2.33,NA,2.33,,0.62,5.33,5.33,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61246707,,Repair anorectal fist w/plug,A,,6.23,7.48,NA,7.48,,1.66,15.37,15.37,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00