No office rate
Use 46744 when the cloacal repair is performed through a perineal approach alone; 46748 represents a combined abdominal and perineal repair.
On this page
CMS RVU26D · Effective 2026-10-01
46748 Cloacal repair Medicare reimbursement rates in California
Reports definitive reconstruction of a congenital cloacal anomaly when the surgeon uses both abdominal and perineal approaches during the repair. Compare 46748 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 46748 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
$3766.97–$4320.37
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $553.40 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 46748 pays more and less in California
Pediatric surgery
About 46748: Combined approach cloacal anomaly repair
Reports definitive reconstruction of a congenital cloacal anomaly when the surgeon uses both abdominal and perineal approaches during the repair.
A cloacal anomaly is a congenital malformation in which the urinary, genital, and intestinal tracts share a common outlet. This service covers complex reconstruction using both abdominal and perineal access to separate or reconstruct the involved pathways. It is generally performed in a hospital operating room by a pediatric surgeon with expertise in congenital pelvic reconstruction. The operative report should establish the anomaly and document the use of both approaches as part of the repair.
Choose this code when the repair uses both abdominal and perineal approaches; codes 46744 and 46746 describe repairs using a single approach. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If other 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 anatomy. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 46748
- 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 RVU69.63 · 59%
- Practice expense (office) RVU29.17 · 25%
- Malpractice RVU18.65 · 16%
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.
46748 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
Use 46746 for cloacal repair through an abdominal approach alone. The combined abdominal and perineal approach distinguishes 46748.
No office rate
46742 addresses repair of an imperforate anus. Use 46748 for reconstruction of a cloacal anomaly involving a shared outlet and both surgical approaches.
Compare 46748 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 $3817.09 |
| Chico | Office Unavailable | Facility $3766.97 |
| El Centro | Office Unavailable | Facility $3770.08 |
| Fresno | Office Unavailable | Facility $3766.97 |
| Hanford-Corcoran | Office Unavailable | Facility $3766.97 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $3987.28 |
| Madera | Office Unavailable | Facility $3766.97 |
| Merced | Office Unavailable | Facility $3766.97 |
| Modesto | Office Unavailable | Facility $3766.97 |
| Napa | Office Unavailable | Facility $4072.80 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $3930.54 |
| Redding | Office Unavailable | Facility $3766.97 |
| Rest Of California | Office Unavailable | Facility $3766.97 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $3966.76 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $3876.43 |
| Salinas | Office Unavailable | Facility $3860.91 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $3898.37 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $4206.34 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $4185.16 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $4320.37 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $4233.78 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $3808.86 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $3892.21 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $3860.75 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $3925.81 |
| Stockton | Office Unavailable | Facility $3766.97 |
| Vallejo | Office Unavailable | Facility $4042.28 |
| Visalia | Office Unavailable | Facility $3766.97 |
| Yuba City | Office Unavailable | Facility $3766.97 |
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46748 billing questions
When should I report 46748 instead of 46744 or 46746?
Report 46748 when the cloacal repair uses both abdominal and perineal approaches. The single-approach alternatives are 46744 and 46746.
Does the 90-day global period include routine postoperative visits?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to this anatomy, so modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How does payment change when other procedures are performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What documentation supports choosing this code?
Document the cloacal anomaly, the reconstruction performed, and use of both abdominal and perineal approaches.
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.
5,62046742,,Repair of imperforated anus,A,,39.14,21.47,NA,21.47,,10.49,71.10,71.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62146744,,Repair of cloacal anomaly,A,,57.47,26.06,NA,26.06,,15.39,98.92,98.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62246746,,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