No office rate
Both codes concern anal sphincter repair. Choose the code whose specific variant matches the operative service rather than treating the codes as interchangeable.
On this page
CMS RVU26D · Effective 2026-10-01
46761 Anal sphincter repair Medicare reimbursement rates in Indiana
Reports operative repair of an anal sphincter defect when the documented procedure matches this code’s specific repair variant. Compare 46761 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 46761 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
No supported rate
Facility setting
$767.77
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.
Colorectal surgery
About 46761: Anal sphincter repair
Reports operative repair of an anal sphincter defect when the documented procedure matches this code’s specific repair variant.
The surgeon repairs disrupted anal sphincter muscle to restore continuity and function. The clinical problem may follow childbirth-related injury, trauma, or another acquired defect associated with impaired continence. A colorectal surgeon or another surgeon qualified to perform anorectal reconstruction typically performs the operation in an operating room. The operative report should establish the sphincter defect and describe the repair performed; the diagnosis alone does not identify the appropriate code within the repair family.
Select 46761 only when the operative service matches this code’s specific variant in the current code set. Document the affected anatomy, cause and extent of the defect, operative approach, and repair technique. CMS assigns 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 are subject to the standard 50% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 46761
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.91 · 60%
- Practice expense (office) RVU7.36 · 30%
- Malpractice RVU2.58 · 10%
296
Medicare services in 2024 · #4001 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.
46761 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
This is another code for anal sphincter repair. The operative details and the code-specific variant determine which code applies.
No office rate
46760 is a nearby repair-family code. Compare its specific procedure description with the operative report before choosing between it and 46761.
Compare 46761 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
Unavailable
Facility
$767.77
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.
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 46761 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,629
- Code
- 46761
- Physician work
- 14.91
- Practice expense
- 7.36
- Malpractice
- 2.58
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.91 | × 1.000 | 14.9100 |
| Practice expense | 7.36 | × 0.927 | 6.8227 |
| Malpractice | 2.58 | × 0.486 | 1.2539 |
| Total RVUs | 22.9866 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$767.77
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.91 | 1 |
| Practice expense | 7.36 | 0.927 |
| Malpractice | 2.58 | 0.486 |
(14.91 × 1 + 7.36 × 0.927 + 2.58 × 0.486) × $33.4009 = $767.77
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.
46761 billing questions
How should 46761 be distinguished from other anal sphincter repair codes?
Use the code whose specific repair variant matches the procedure documented in the operative report. Do not select among the family based only on the diagnosis or the fact that the sphincter was repaired.
Is modifier 50 appropriate for this repair?
No. CMS identifies bilateral adjustment as inapplicable because the descriptor or anatomy makes modifier 50 inappropriate.
Are routine postoperative visits separately reported?
Related postoperative care for 90 days is included in the global period, as is the day-before preoperative visit.
How does the multiple-procedure reduction affect 46761?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports reporting 46761?
The operative report should describe the defect, affected sphincter anatomy, approach, and repair technique sufficiently to show that the service matches this specific repair variant.
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.
5,62646753,,Reconstruction of anus,A,,8.67,7.40,NA,7.40,,2.33,18.40,18.40,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62746754,,Removal of suture from anus,A,,2.93,8.07,,3.83,,0.42,11.42,7.18,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62846760,,Repair of anal sphincter,A,,17.01,11.93,NA,11.93,,2.46,31.40,31.40,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62946761,,Repair of anal sphincter,A,,14.91,7.36,NA,7.36,,2.58,24.85,24.85,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63046900,,Destruction anal lesion(s),A,,1.86,5.92,,1.84,,0.26,8.04,3.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63146910,,Destruction anal lesion(s),A,,1.86,6.72,,1.73,,0.30,8.88,3.89,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63246916,,Cryosurgery anal lesion(s),A,,1.86,5.55,,1.60,,0.20,7.61,3.66,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,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