No office rate
46045 is for transanal drainage of a perirectal abscess under anesthesia. 46040 describes external drainage of an ischiorectal or intramural abscess.
On this page
CMS RVU26D · Effective 2026-10-01
46040 Abscess drainage Medicare reimbursement rates in Iowa
Reports external incision and drainage of an ischiorectal or intramural abscess, where the abscess location distinguishes it from superficial perianal drainage. Compare 46040 office and facility rates across CMS payment localities in Iowa.
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 46040 in Iowa?
Iowa 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
$570.82
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$392.03
1 of 1 localities have a supported rate.
Payment area: Iowa
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 46040: Ischiorectal abscess incision and drainage
Reports external incision and drainage of an ischiorectal or intramural abscess, where the abscess location distinguishes it from superficial perianal drainage.
This operation drains an abscess in the ischiorectal space or within the rectal wall through an external incision. A general or colorectal surgeon typically performs it in an operating room or, when clinically appropriate, another procedure setting. The surgeon opens the infected cavity, evacuates its contents, and provides drainage; the operative note should identify the abscess location and approach.
Select the code based on the documented site and procedure, not simply the diagnosis of anorectal abscess. A superficial perianal collection or a transanal drainage approach points to a different code; when fistula surgery accompanies drainage, consider the code that includes that work. Medicare treats this 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 for this service. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46040
- 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 RVU5.24 · 28%
- Practice expense (office) RVU12.43 · 66%
- Malpractice RVU1.20 · 6%
3.3K
Medicare services in 2024 · #2115 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.
46040 compared with similar codes
Office rates for Iowa, from the same CMS release.
$243.78
46050 is for a superficial perianal abscess. Choose 46040 when the documented abscess is ischiorectal or intramural and drained externally.
No office rate
46060 includes abscess drainage with fistulectomy or fistulotomy. Use 46040 when the reported service is drainage without that fistula surgery.
Compare 46040 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
Iowa →
Office / nonfacility
$570.82
Facility
$392.03
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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 46040 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,572
- Code
- 46040
- Physician work
- 5.24
- Practice expense
- 12.43
- Malpractice
- 1.20
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.24 | × 1.000 | 5.2400 |
| Practice expense | 12.43 | × 0.915 | 11.3735 |
| Malpractice | 1.20 | × 0.397 | 0.4764 |
| Total RVUs | 17.0899 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$570.82
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.24 | 1 |
| Practice expense | 12.43 | 0.915 |
| Malpractice | 1.2 | 0.397 |
(5.24 × 1 + 12.43 × 0.915 + 1.2 × 0.397) × $33.4009 = $570.82
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.24 | 1 |
| Practice expense | 6.58 | 0.915 |
| Malpractice | 1.2 | 0.397 |
(5.24 × 1 + 6.58 × 0.915 + 1.2 × 0.397) × $33.4009 = $392.03
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.
46040 billing questions
How is 46040 distinguished from superficial perianal abscess drainage?
Use 46040 for an ischiorectal-space or intramural abscess drained through an external incision. A superficial perianal collection is described by 46050.
When is 46045 a better choice?
46045 describes transanal drainage of a perirectal abscess under anesthesia. For 46040, the operative documentation should support an external approach to an ischiorectal or intramural abscess.
Can 46040 be reported with 46060?
When the surgeon treats an associated fistula with fistulectomy or fistulotomy during abscess drainage, consider 46060, which includes that additional work. Do not report both codes for the same drainage service.
What documentation supports 46040?
The operative report should identify the abscess as ischiorectal or intramural and describe the external incision, drainage, and cavity findings. A generic diagnosis of anorectal abscess alone does not establish the site or approach.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for 46040.
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.
5,56945999,,Unlisted procedure rectum,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57046020,,Placement of seton,A,,1.81,1.15,NA,1.15,,0.36,3.32,3.32,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57146030,,Removal anal seton oth mrk,A,,1.44,6.82,,0.73,,0.24,8.50,2.41,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57246040,,I&d ischiorct&/perirct absc,A,,5.24,12.43,,6.58,,1.20,18.87,13.02,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57346045,,I&d absc tranal under anes,A,,5.72,6.43,NA,6.43,,1.25,13.40,13.40,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57446050,,I&d perianal abscess supfc,A,,1.21,6.55,,1.65,,0.24,8.00,3.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57546060,,I&d ischiorectal/ntrmrl absc,A,,6.21,7.31,NA,7.31,,1.20,14.72,14.72,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136