No office rate
Both address an anorectal fistula without describing a cutting fistulotomy. Choose 46707 for a plug placed in the tract and 46706 for glue.
On this page
CMS RVU26D · Effective 2026-10-01
46707 Fistula repair Medicare reimbursement rates in Illinois
Reports operative repair of an anorectal fistula by placing a plug in the tract, rather than using glue or cutting open the tract. Compare 46707 office and facility rates across CMS payment localities in Illinois.
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 46707 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$522.85–$587.88
4 of 4 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 46707 pays more and less in Illinois
Anorectal surgery
About 46707: Anorectal fistula repair with plug
Reports operative repair of an anorectal fistula by placing a plug in the tract, rather than using glue or cutting open the tract.
A colorectal or general surgeon uses this repair to treat an anorectal fistula by placing a plug within the fistula tract. The plug approach closes the tract while avoiding a cutting fistulotomy. The procedure is typically performed in an operating facility, where the surgeon can identify the tract and position the plug.
Select this code when the operative report documents placement of a fistula plug, rather than injection of glue or a fistulotomy. Document the tract treated and the material placed; preparing the tract and positioning the plug are steps of the repair, not additional plug repairs. Medicare treats this as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this anatomy. An assistant surgeon is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 46707
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.23 · 41%
- Practice expense (office) RVU7.48 · 49%
- Malpractice RVU1.66 · 11%
23
Medicare services in 2024 · #5846 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.
46707 compared with similar codes
Office rates for Illinois, from the same CMS release.
$583.13–$645.86
Code 46270 describes surgical opening or removal of a subcutaneous anal fistula tract. Choose 46707 when the documented repair uses a plug.
$612.37–$676.34
Code 46275 describes surgical opening or removal of an intersphincteric anal fistula tract. Code 46707 identifies repair by plug placement rather than that cutting approach.
Compare 46707 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
Unavailable
Facility
$587.88
East St. Louis →
Office / nonfacility
Unavailable
Facility
$549.61
Rest Of Illinois →
Office / nonfacility
Unavailable
Facility
$522.85
Suburban Chicago →
Office / nonfacility
Unavailable
Facility
$564.38
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46707 billing questions
When is 46707 reported instead of 46706?
Report 46707 when the surgeon places a plug in the anorectal fistula tract. Code 46706 describes repair using glue instead.
Is tract preparation separately reported from plug placement?
Preparing the fistula tract and positioning the plug are part of the plug repair. The operative report should establish that a plug was placed.
What postoperative care is included?
The code has a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How does Medicare pay this repair when another procedure is performed in the same session?
The standard multiple-procedure reduction applies: the highest-valued procedure is paid in full and other procedures at 50%.
Should modifier 50 be used for two fistula tracts?
No. The bilateral adjustment does not apply to this anorectal repair, and modifier 50 is inappropriate.
Can another surgeon assist with the plug repair?
An assistant at surgery is paid only with documentation of medical necessity. Medicare does not permit co-surgeons or team surgery for this code.
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.
5,60946700,,Repair of anal stricture,A,,9.56,8.00,NA,8.00,,1.59,19.15,19.15,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61046705,,Repair of anal stricture,A,,7.24,8.09,NA,8.09,,1.93,17.26,17.26,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61146706,,Repr of anal fistula w/glue,A,,2.38,2.33,NA,2.33,,0.62,5.33,5.33,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61246707,,Repair anorectal fist w/plug,A,,6.23,7.48,NA,7.48,,1.66,15.37,15.37,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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