$575.04
Use 46270 for a tract limited to subcutaneous tissue; 46275 is for an intersphincteric tract.
On this page
CMS RVU26D · Effective 2026-10-01
46270 Anal fistula surgery Medicare reimbursement rates in Iowa
Reports surgical treatment of a superficial anal fistula confined to the subcutaneous tissue, without a deeper tract involving the sphincter muscles. Compare 46270 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 46270 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
$545.39
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$369.96
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 46270: Subcutaneous anal fistula surgery
Reports surgical treatment of a superficial anal fistula confined to the subcutaneous tissue, without a deeper tract involving the sphincter muscles.
This service treats a superficial anal fistula whose tract is confined to tissue beneath the skin around the anus. The surgeon opens or excises the tract to treat the fistula. Colorectal and general surgeons typically perform the procedure in an operating room or ambulatory surgery setting. The operative note should establish the tract’s course and its relationship to the sphincter muscles.
Select this code by the documented anatomy and extent of the fistula, not simply by the fact that a fistula was treated. A tract involving the sphincter or a complex course points to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 46270
- 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 RVU4.80 · 27%
- Practice expense (office) RVU12.17 · 68%
- Malpractice RVU0.99 · 6%
1.5K
Medicare services in 2024 · #2668 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.
46270 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
46270 identifies a subcutaneous tract, while 46280 is for a complex fistula. The operative findings determine which anatomy is documented.
$575.17
46285 describes staged fistula treatment. 46270 is selected for a subcutaneous fistula treated surgically, not because treatment is staged.
Compare 46270 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
$545.39
Facility
$369.96
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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 46270 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,590
- Code
- 46270
- Physician work
- 4.80
- Practice expense
- 12.17
- Malpractice
- 0.99
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.80 | × 1.000 | 4.8000 |
| Practice expense | 12.17 | × 0.915 | 11.1356 |
| Malpractice | 0.99 | × 0.397 | 0.3930 |
| Total RVUs | 16.3286 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$545.39
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.8 | 1 |
| Practice expense | 12.17 | 0.915 |
| Malpractice | 0.99 | 0.397 |
(4.8 × 1 + 12.17 × 0.915 + 0.99 × 0.397) × $33.4009 = $545.39
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.8 | 1 |
| Practice expense | 6.43 | 0.915 |
| Malpractice | 0.99 | 0.397 |
(4.8 × 1 + 6.43 × 0.915 + 0.99 × 0.397) × $33.4009 = $369.96
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.
46270 billing questions
How does 46270 differ from 46275?
46270 is for a fistula confined to subcutaneous tissue. Use 46275 when the documented tract is intersphincteric.
When is 46280 a better fit?
46280 describes treatment of a complex anal fistula. Choose based on the documented tract anatomy and complexity rather than the procedure name alone.
Can 46270 be reported with modifier 50?
No. The anatomy and service do not support bilateral adjustment, so modifier 50 is inappropriate.
What documentation supports 46270?
Document the fistula tract’s course, its depth and relationship to the sphincter muscles, and the surgical treatment performed.
Are related postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Can an assistant surgeon or co-surgeon be paid for 46270?
Medicare does not pay an assistant at surgery for this service. 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.
5,58746260,,Remove in/ex hem groups 2+,A,,6.56,6.46,NA,6.46,,1.34,14.36,14.36,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58846261,,Remove in/ex hem grps & fiss,A,,7.57,6.42,NA,6.42,,1.44,15.43,15.43,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58946262,,Remove in/ex hem grps w/fist,A,,7.71,7.83,NA,7.83,,2.06,17.60,17.60,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59046270,,Remove anal fist subq,A,,4.80,12.17,,6.43,,0.99,17.96,12.22,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59146275,,Remove anal fist inter,A,,5.28,12.62,,6.47,,0.98,18.88,12.73,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59246280,,Remove anal fist complex,A,,6.23,7.06,NA,7.06,,1.16,14.45,14.45,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59346285,,Remove anal fist 2 stage,A,,5.28,12.62,,6.51,,0.99,18.89,12.78,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,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