Billing code 46080: Anal sphincterotomyMedicare rate & RVUs in Illinois
Reports surgical division of the anal sphincter, commonly to treat a chronic anal fissure when sphincterotomy is the performed procedure.
Medicare pays $305.96–$338.49 for 46080 in the office in Illinois, from Rest Of Illinois to Chicago. 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 46080 covers
This procedure divides anal sphincter muscle, most often the internal sphincter in a lateral sphincterotomy for a chronic anal fissure. A colorectal or general surgeon typically performs it in an operating room or outpatient surgical facility. The operative note should identify the indication and describe the sphincter division performed.
Report 46080 when sphincterotomy itself is the service. If the surgeon excises the fissure and performs sphincterotomy as part of that operation, report 46200 rather than separately reporting 46080 for the included sphincterotomy. The 10-day global period includes related postoperative visits during that period. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery 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 46080 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$305.96 to $338.49
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $338.49 | $172.00 |
| East St. Louis | $314.87 | $162.45 |
| Rest Of Illinois | $305.96 | $154.71 |
| Suburban Chicago | $334.71 | $164.57 |
How the 46080 rate is calculated
Each of 46080’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 · 46080
RVUs × geographic indexes × conversion factor
Work2.46
2.46 RVUs× 1.000 GPCI
Practice expense6.50
6.50 RVUs× 1.000 GPCI
Malpractice0.49
0.49 RVUs× 1.000 GPCI
Adjusted RVUs
9.4500
Conversion factor
$33.4009
Medicare rate
$315.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46080
46080 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46080
Anal sphincterotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46080
Anal sphincterotomy
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46080 without 51 · national office
$315.64
Anal sphincterotomy
46080-51 · Second procedure: 50%
$157.82
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%).
46080 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46200Fissure surgery
- This code includes fissure excision and may include sphincterotomy. Report 46080 when sphincter division is the service, not when it is included in the fissurectomy.
- 46045Abscess drainage
- 46045 reports transanal drainage of an anorectal abscess under anesthesia; 46080 divides sphincter muscle and is not an abscess-drainage code.
- 46050Perianal abscess drainage
- 46050 is for drainage of a superficial perianal abscess. Choose 46080 for sphincter division, not for incision and drainage of a superficial abscess.
- 46070Anal septum incision
- 46070 treats an anal septum in an infant. It is not the sphincter-division procedure reported with 46080.
46080 billing questions
When should 46080 be reported instead of 46200?
Report 46080 when the service is sphincter division. Use 46200 when the surgeon performs fissurectomy and includes sphincterotomy in that operation; do not separately report 46080 for the included division.
What documentation supports 46080?
Document the indication, the sphincter muscle divided, and the operative technique. For a fissure, the note should make clear that sphincterotomy was performed rather than only an examination or another anorectal procedure.
Can modifier 50 be used for bilateral sphincterotomy?
No. The CMS bilateral adjustment does not apply to 46080, and modifier 50 is inappropriate for this code.
Are postoperative visits separately reportable during the global period?
Related postoperative visits for 10 days are included in the procedure's global period.
How does the multiple-procedure rule affect 46080?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 46080. Co-surgeons and team surgery are 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 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
Fee sheets
Put 46080 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →