No office rate
Both codes address imperforate anus with fistula anatomy. Distinguish them using the specific fistula type documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
46716 Anorectal repair Medicare reimbursement rates in Florida
Surgical repair for imperforate anus with an anoperineal or vestibular fistula, selected according to the congenital anatomy documented by the surgeon. Compare 46716 office and facility rates across CMS payment localities in Florida.
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 46716 in Florida?
Florida has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1270.29–$1468.66
3 of 3 localities have a supported rate.
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 46716 pays more and less in Florida
Pediatric colorectal surgery
About 46716: Imperforate anus repair with fistula
Surgical repair for imperforate anus with an anoperineal or vestibular fistula, selected according to the congenital anatomy documented by the surgeon.
This code describes operative correction of imperforate anus when the congenital anorectal opening communicates through an anoperineal or vestibular fistula. A pediatric surgeon or colorectal surgeon typically performs the reconstruction in an operating room, often as part of treatment for an anorectal malformation identified in infancy or childhood. The operative report should establish the congenital defect and the fistula’s site; an acquired fistula-in-ano is a different clinical problem.
Select the code from the documented malformation and fistula anatomy, rather than from the repair’s general complexity alone. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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 for this code. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 46716
- 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 RVU17.10 · 47%
- Practice expense (office) RVU14.71 · 40%
- Malpractice RVU4.57 · 13%
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.
46716 compared with similar codes
Office rates for Florida, from the same CMS release.
No office rate
This code identifies the anoperineal or vestibular fistula context; 46742 is a separate imperforate-anus repair code, selected according to its documented anatomy and procedure.
No office rate
46706 describes treatment of an anorectal fistula using fibrin glue. It is not the congenital imperforate-anus repair represented here.
No office rate
46707 uses a plug to treat an anorectal fistula; this code is for congenital imperforate anus associated with an anoperineal or vestibular fistula.
Compare 46716 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.
3 of 3 payment localities
Fort Lauderdale →
Office / nonfacility
Unavailable
Facility
$1344.85
Miami →
Office / nonfacility
Unavailable
Facility
$1468.66
Rest Of Florida →
Office / nonfacility
Unavailable
Facility
$1270.29
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46716 billing questions
How is this different from code 46715?
Both concern congenital imperforate anus with fistula anatomy. Use the documented fistula type to distinguish the anoperineal category from the anoperineal or vestibular category represented by this code.
Is this for an acquired fistula-in-ano?
No. This code is for repair of imperforate anus associated with a congenital anoperineal or vestibular fistula, not a typical acquired anal fistula.
Can a separate fistula procedure be reported at the same session?
Report another procedure only when the surgeon documents a distinct service beyond the repair represented by this code. When multiple procedures are performed in the same session, CMS applies the standard multiple procedure reduction.
Should modifier 50 be used for a bilateral repair?
No. Modifier 50 is inappropriate for this code’s descriptor and anatomy.
What documentation supports code selection?
The operative report should identify imperforate anus and describe the fistula’s site and the repair performed. Those anatomic details distinguish this service from other congenital anorectal repairs.
How are assistant and co-surgeon services treated?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
5,61346710,,Repr per/vag pouch sngl proc,A,,16.71,10.80,NA,10.80,,4.46,31.97,31.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61446712,,Repr per/vag pouch dbl proc,A,,35.54,17.12,NA,17.12,,9.52,62.18,62.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61546715,,Rep perf anoper fistu,A,,7.43,7.18,NA,7.18,,1.98,16.59,16.59,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61646716,,Rep perf anoper/vestib fistu,A,,17.10,14.71,NA,14.71,,4.57,36.38,36.38,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61746730,,Construction of absent anus,A,,29.88,19.23,NA,19.23,,8.00,57.11,57.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61846735,,Construction of absent anus,A,,35.24,20.52,NA,20.52,,9.42,65.18,65.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61946740,,Construction of absent anus,A,,33.05,20.14,NA,20.14,,8.85,62.04,62.04,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00