No office rate
Use this combined code when fissure treatment accompanies hemorrhoidectomy for one internal or external hemorrhoid group; 46200 describes fissure excision without that combined service.
On this page
CMS RVU26D · Effective 2026-10-01
46200 Fissure surgery Medicare reimbursement rates in Indiana
Reports operative removal of diseased anal fissure tissue, including sphincterotomy when performed, when the fissure is treated surgically. Compare 46200 office and facility rates across CMS payment localities in Indiana.
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 46200 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$491.69
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$322.02
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
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.
Anorectal surgery
About 46200: Anal fissure excision with sphincterotomy
Reports operative removal of diseased anal fissure tissue, including sphincterotomy when performed, when the fissure is treated surgically.
The surgeon removes diseased tissue from an anal fissure; sphincterotomy is included when performed as part of the operation. Colorectal and general surgeons typically perform this procedure in an operating room under anesthesia for a fissure requiring surgical treatment. The operative report should identify the fissure and describe the excision and any sphincter work performed.
Select this code when the fissure itself is excised. When hemorrhoidectomy and fissure treatment are performed together, consider the combined hemorrhoidectomy-and-fissure codes 46257 or 46261 according to the hemorrhoid groups treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces other procedures to 50%. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 46200
- 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 RVU3.50 · 22%
- Practice expense (office) RVU11.79 · 74%
- Malpractice RVU0.60 · 4%
818
Medicare services in 2024 · #3126 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.
46200 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
This combined code describes fissure treatment with hemorrhoidectomy for two or more groups. Choose 46200 when the operative service is fissure excision without that hemorrhoidectomy.
$255.00
This code targets an anal papilla, not the fissure. Choose 46200 when the surgeon excises diseased fissure tissue.
$316.51
This code targets anal tags. It is not a substitute for fissure excision when the operative target is the fissure.
Compare 46200 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.
1 of 1 payment localities
Indiana →
Office / nonfacility
$491.69
Facility
$322.02
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 46200 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,579
- Code
- 46200
- Physician work
- 3.50
- Practice expense
- 11.79
- Malpractice
- 0.60
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.50 | × 1.000 | 3.5000 |
| Practice expense | 11.79 | × 0.927 | 10.9293 |
| Malpractice | 0.60 | × 0.486 | 0.2916 |
| Total RVUs | 14.7209 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$491.69
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1 |
| Practice expense | 11.79 | 0.927 |
| Malpractice | 0.6 | 0.486 |
(3.5 × 1 + 11.79 × 0.927 + 0.6 × 0.486) × $33.4009 = $491.69
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1 |
| Practice expense | 6.31 | 0.927 |
| Malpractice | 0.6 | 0.486 |
(3.5 × 1 + 6.31 × 0.927 + 0.6 × 0.486) × $33.4009 = $322.02
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
46200 billing questions
When should 46200 be reported instead of 46257 or 46261?
Report 46200 when the operation excises the fissure without the qualifying hemorrhoidectomy described by a combined code. Codes 46257 and 46261 combine fissure treatment with hemorrhoidectomy for the specified hemorrhoid groups.
Is sphincterotomy separately reported with 46200?
Sphincterotomy performed as part of the fissure operation is included in 46200. The operative report should document the work performed.
Does modifier 50 apply to 46200?
No. The anal anatomy and service are not reported bilaterally, so modifier 50 is inappropriate.
How does the 90-day global period affect postoperative visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are not separately reported as routine postoperative visits.
What happens when another procedure is performed in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedure or procedures to 50%. An assistant at surgery is not paid, and 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 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.
5,57646070,,Incision anal septum infant,A,,2.72,5.23,NA,5.23,,0.72,8.67,8.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57746080,,Sphnctrotmy anal div sphnctr,A,,2.46,6.50,,1.54,,0.49,9.45,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57846083,,Inc thrombosed hroid xtrnl,A,,1.41,5.06,,1.53,,0.28,6.75,3.22,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57946200,,Removal of anal fissure,A,,3.50,11.79,,6.31,,0.60,15.89,10.41,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58046220,,Excise anal ext tag/papilla,A,,1.57,6.39,,1.72,,0.29,8.25,3.58,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58146221,,Ligation of hemorrhoid(s),A,,2.30,7.09,,3.24,,0.36,9.75,5.90,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58246230,,Removal of anal tags,A,,2.55,7.22,,1.95,,0.48,10.25,4.98,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915