Billing code 46040: Abscess drainageMedicare rate & RVUs in Florida
Reports external incision and drainage of an ischiorectal or intramural abscess, where the abscess location distinguishes it from superficial perianal drainage.
Medicare pays $632.17–$708.58 for 46040 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 46040 covers
This operation drains an abscess in the ischiorectal space or within the rectal wall through an external incision. A general or colorectal surgeon typically performs it in an operating room or, when clinically appropriate, another procedure setting. The surgeon opens the infected cavity, evacuates its contents, and provides drainage; the operative note should identify the abscess location and approach.
Select the code based on the documented site and procedure, not simply the diagnosis of anorectal abscess. A superficial perianal collection or a transanal drainage approach points to a different code; when fistula surgery accompanies drainage, consider the code that includes that work. Medicare treats this as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 46040 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.
3 payment localities
$632.17 to $708.58
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $668.06 | $470.12 |
| Miami | $708.58 | $505.17 |
| Rest Of Florida | $632.17 | $445.37 |
How the 46040 rate is calculated
Each of 46040’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 · 46040
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.24Practice expense 12.43Malpractice 1.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46040
46040 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46040
Abscess drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46040
Abscess drainage
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46040 without 51 · national office
$630.27
Abscess drainage
46040-51 · Second procedure: 50%
$315.14
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%).
46040 compared with similar codes
Compare codes
46040 vs 46045 vs 46050 vs 46060: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46045Abscess drainage
- 46045 is for transanal drainage of a perirectal abscess under anesthesia. 46040 describes external drainage of an ischiorectal or intramural abscess.
- 46050Perianal abscess drainage
- 46050 is for a superficial perianal abscess. Choose 46040 when the documented abscess is ischiorectal or intramural and drained externally.
- 46060Abscess drainage
- 46060 includes abscess drainage with fistulectomy or fistulotomy. Use 46040 when the reported service is drainage without that fistula surgery.
46040 billing questions
How is 46040 distinguished from superficial perianal abscess drainage?
Use 46040 for an ischiorectal-space or intramural abscess drained through an external incision. A superficial perianal collection is described by 46050.
When is 46045 a better choice?
46045 describes transanal drainage of a perirectal abscess under anesthesia. For 46040, the operative documentation should support an external approach to an ischiorectal or intramural abscess.
Can 46040 be reported with 46060?
When the surgeon treats an associated fistula with fistulectomy or fistulotomy during abscess drainage, consider 46060, which includes that additional work. Do not report both codes for the same drainage service.
What documentation supports 46040?
The operative report should identify the abscess as ischiorectal or intramural and describe the external incision, drainage, and cavity findings. A generic diagnosis of anorectal abscess alone does not establish the site or approach.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 46040.
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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