$562.33–$613.51
Use 46270 for a subcutaneous fistula tract beneath the skin. Use 46275 when the tract runs between the internal and external sphincters.
On this page
CMS RVU26D · Effective 2026-10-01
46275 Fistula surgery Medicare reimbursement rates in Georgia
Report 46275 for operative treatment of an anal fistula that runs between the internal and external sphincters, based on documented tract anatomy. Compare 46275 office and facility rates across CMS payment localities in Georgia.
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 46275 in Georgia?
Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$591.37–$644.46
2 of 2 localities have a supported rate.
Facility setting
$408.14–$435.76
2 of 2 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.
Colorectal surgery
About 46275: Intersphincteric anal fistula surgery
Report 46275 for operative treatment of an anal fistula that runs between the internal and external sphincters, based on documented tract anatomy.
Code 46275 describes operative treatment of an anal fistula whose tract lies between the internal and external anal sphincters. The surgeon identifies the tract and opens or removes it as appropriate to the documented anatomy. Colorectal and general surgeons commonly perform this procedure in an operating room or ambulatory surgery setting. It is distinct from treatment of a superficial tract beneath the skin and from procedures for complex or staged fistulas.
Report this code when the operative findings and technique support an intersphincteric fistula; do not select it based on the external opening alone. The operative note should identify the tract course, sphincter involvement, treatment performed, and any associated procedure. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and remaining procedures at 50%. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 46275
- 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 RVU5.28 · 28%
- Practice expense (office) RVU12.62 · 67%
- Malpractice RVU0.98 · 5%
1K
Medicare services in 2024 · #2972 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.
46275 compared with similar codes
Office rates for Georgia, from the same CMS release.
No office rate
46280 is for complex fistula anatomy; 46275 is for an intersphincteric tract. Base the choice on the operative findings and tract course.
$591.77–$644.86
46285 represents a two-stage fistula treatment approach. Choose 46275 for treatment of an intersphincteric tract when the documented procedure is not staged.
No office rate
46258 describes excision of an internal or external hemorrhoid group with fistula treatment. Compare it when both services are performed together rather than reporting only the fistula service.
Compare 46275 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.
2 of 2 payment localities
Atlanta →
Office / nonfacility
$644.46
Facility
$435.76
Rest Of Georgia →
Office / nonfacility
$591.37
Facility
$408.14
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
46275 billing questions
How is 46275 distinguished from 46270?
46275 is for an intersphincteric tract between the anal sphincters. Code 46270 is for a subcutaneous tract, so document the tract’s course and sphincter relationship.
What documentation supports reporting 46275?
The operative report should describe the fistula’s course, its relationship to the sphincters, and the treatment performed. The external opening alone does not establish the intersphincteric anatomy.
Can 46275 be reported with hemorrhoid excision?
When the surgeon also excises an internal or external hemorrhoid group and treats the fistula, compare the combined service with 46258. Other procedures performed in the same session are subject to the standard multiple-procedure payment reduction.
Can modifier 50 be used for 46275?
No. The anatomy is not appropriate for bilateral modifier 50 reporting.
How does the global period affect follow-up visits?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
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.
5,58846261,,Remove in/ex hem grps & fiss,A,,7.57,6.42,NA,6.42,,1.44,15.43,15.43,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58946262,,Remove in/ex hem grps w/fist,A,,7.71,7.83,NA,7.83,,2.06,17.60,17.60,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59046270,,Remove anal fist subq,A,,4.80,12.17,,6.43,,0.99,17.96,12.22,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59146275,,Remove anal fist inter,A,,5.28,12.62,,6.47,,0.98,18.88,12.73,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59246280,,Remove anal fist complex,A,,6.23,7.06,NA,7.06,,1.16,14.45,14.45,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59346285,,Remove anal fist 2 stage,A,,5.28,12.62,,6.51,,0.99,18.89,12.78,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59446288,,Repair anal fistula,A,,7.61,7.50,NA,7.50,,1.43,16.54,16.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00