Billing code 46020: Seton placementMedicare rate & RVUs in Florida
Reports placement of a loop through an anal fistula tract to maintain drainage, often as part of staged management of complex fistula disease.
CMS doesn’t publish an office rate for 46020 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 46020 covers
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.
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.
Where 46020 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $121.11 |
| Miami | Unavailable | $130.85 |
| Rest Of Florida | Unavailable | $115.25 |
How the 46020 rate is calculated
Each of 46020’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46020
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.81Practice expense 1.15Malpractice 0.36
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46020
The CMS indicators that decide how 46020 is paid alongside other services.
CMS payment indicators · 46020
Seton placement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46020 without 51 · national facility
$110.89
Seton placement
46020-51 · Second procedure: 50%
$55.45
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
46020 compared with similar codes
Compare codes
46020 vs 46030 vs 46040 vs 46270: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46030Seton removal
- 46020 reports placement of a seton; 46030 reports removal of an anal seton. Use the code matching the work performed during the encounter.
- 46040Abscess drainage
- 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.
- 46270Anal fistula surgery
- 46270 applies when a superficial anal fistula is treated by opening the tract. Choose 46020 when the documented service is seton placement.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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