$545.39
46270 is for a subcutaneous fistula treatment. Choose 46285 when the procedure is staged and includes seton placement.
On this page
CMS RVU26D · Effective 2026-10-01
46285 Anal fistula surgery Medicare reimbursement rates in Iowa
Report staged surgical treatment of an anal fistula with seton placement when the operative plan treats the tract in separate stages rather than definitively at one operation. Compare 46285 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 46285 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
$575.17
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$388.44
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.
Anorectal surgery
About 46285: Staged anal fistula surgery with seton
Report staged surgical treatment of an anal fistula with seton placement when the operative plan treats the tract in separate stages rather than definitively at one operation.
A colorectal or general surgeon uses this code for an operative plan that treats an anal fistula in stages, including placement of a seton to maintain drainage between procedures. Staged management may be selected when immediate division of the tract could threaten sphincter function. The procedure is generally performed in an operating room, with the operative report documenting the fistula tract, seton placement, and staged treatment plan.
Report this code for the staged seton procedure, not for a single-stage operation selected by fistula anatomy or for a repair coded by its method. The record should support that treatment is staged and describe the work performed during the encounter. CMS classifies the service as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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; assistant-at-surgery payment is statutorily restricted, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46285
- 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 RVU5.28 · 28%
- Practice expense (office) RVU12.62 · 67%
- Malpractice RVU0.99 · 5%
183
Medicare services in 2024 · #4404 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.
46285 compared with similar codes
Office rates for Iowa, from the same CMS release.
$575.04
46275 identifies treatment of an intersphincteric fistula; 46285 identifies staged treatment with a seton.
No office rate
46280 is used for specified complex fistula anatomy. 46285 is distinguished by the staged seton approach.
No office rate
46288 represents anal fistula repair, while 46285 is for staged treatment with seton placement.
Compare 46285 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
$575.17
Facility
$388.44
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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 46285 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,593
- Code
- 46285
- Physician work
- 5.28
- Practice expense
- 12.62
- 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 | 5.28 | × 1.000 | 5.2800 |
| Practice expense | 12.62 | × 0.915 | 11.5473 |
| Malpractice | 0.99 | × 0.397 | 0.3930 |
| Total RVUs | 17.2203 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$575.17
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.28 | 1 |
| Practice expense | 12.62 | 0.915 |
| Malpractice | 0.99 | 0.397 |
(5.28 × 1 + 12.62 × 0.915 + 0.99 × 0.397) × $33.4009 = $575.17
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.28 | 1 |
| Practice expense | 6.51 | 0.915 |
| Malpractice | 0.99 | 0.397 |
(5.28 × 1 + 6.51 × 0.915 + 0.99 × 0.397) × $33.4009 = $388.44
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.
46285 billing questions
When should I choose 46285 over an anatomy-specific fistula code?
Use 46285 when the operative plan is staged and includes seton placement. Codes 46270, 46275, and 46280 describe treatment selected by fistula anatomy or complexity.
Does 46285 include seton placement?
Yes. Seton placement is part of the staged fistula treatment represented by this code.
What documentation supports 46285?
Document the fistula tract, seton placement, and the plan to treat the fistula in stages. The operative report should identify the work performed during that session.
Can I report modifier 50 for bilateral fistulas?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
Can an assistant or co-surgeon be billed for 46285?
CMS payment for an assistant at surgery is statutorily restricted. Co-surgeon and team-surgery billing are not permitted for this code.
How does the 90-day global period affect follow-up?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures occur in the same session, the standard multiple-procedure reduction applies.
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.
5,59046270,,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
5,59446288,,Repair anal fistula,A,,7.61,7.50,NA,7.50,,1.43,16.54,16.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59546320,,Removal of hemorrhoid clot,A,,1.60,5.08,,1.36,,0.28,6.96,3.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59646500,,Injection into hemorrhoid(s),A,,1.70,8.75,,3.85,,0.27,10.72,5.82,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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