Billing code 46746: Cloacal repairMedicare rate & RVUs in Illinois
Reports abdominal-approach reconstruction of a congenital cloacal malformation, in which urinary, genital, and intestinal tracts converge into a shared channel.
CMS doesn’t publish an office rate for 46746 in Illinois.
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 46746 covers
This code describes operative reconstruction of a congenital cloacal malformation through an abdominal approach. In this rare anomaly, the urinary, genital, and intestinal tracts converge into a shared channel or opening. The procedure is generally performed in a hospital operating room by a pediatric colorectal or general surgeon, sometimes with pediatric urology or gynecology expertise involved based on the anatomy and operative plan.
Select this code when the operative report documents repair of a cloacal anomaly using an abdominal approach; the perineal-only and combined abdominal-perineal approaches have separate sibling codes. Documentation should identify the anomaly, operative route, reconstructive work, and any separately participating surgeons. CMS classifies the service 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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 46746 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.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $4,387.01 |
| East St. Louis | Unavailable | $4,132.97 |
| Rest Of Illinois | Unavailable | $3,869.19 |
| Suburban Chicago | Unavailable | $4,109.04 |
How the 46746 rate is calculated
Each of 46746’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 · 46746
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 63.80Practice expense 27.76Malpractice 17.08
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46746
46746 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46746
Cloacal repair
| 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 46746
Cloacal repair
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
46746 without 51 · national facility
$3,628.67
Cloacal repair
46746-51 · Second procedure: 50%
$1,814.34
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%).
46746 compared with similar codes
Compare codes
46746 vs 46744 vs 46748 vs 46742: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46744Cloacal repair
- This code is for the abdominal approach; 46744 is used when the cloacal repair is performed through a perineal approach.
- 46748Cloacal repair
- Use 46748 when the repair uses both abdominal and perineal approaches. This code identifies the abdominal approach.
- 46742Anorectal repair
- 46742 is for repair of imperforate anus. Use this code when the operative diagnosis and repair are for a cloacal anomaly.
46746 billing questions
How is this code distinguished from the other cloacal repair codes?
Use this code for the abdominal approach. The sibling codes distinguish a perineal-only approach from a combined abdominal and perineal approach.
What documentation supports reporting this code?
The operative report should establish the cloacal anomaly, describe the abdominal route, and document the reconstructive work performed.
Does the code include related postoperative care?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this repair and its anatomy.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction.
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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