No office rate
Choose 46735 for the abdominal approach. Code 46730 describes the perineal approach to construction.
On this page
CMS RVU26D · Effective 2026-10-01
46735 Anorectal reconstruction Medicare reimbursement rates in Iowa
Reports abdominal construction of an anal outlet for a congenital absent or imperforate anus when the operative repair uses an abdominal approach. Compare 46735 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 46735 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
No supported rate
Facility setting
$1929.09
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 46735: Absent anus reconstruction, abdominal approach
Reports abdominal construction of an anal outlet for a congenital absent or imperforate anus when the operative repair uses an abdominal approach.
This operation creates an anal outlet for a patient with a congenital absent or imperforate anus using abdominal access. The surgeon mobilizes the rectum and brings it into position for reconstruction; the specific technique depends on the anatomy and operative plan. Pediatric surgeons and colorectal surgeons typically perform the procedure in an operating room, often as part of care for a congenital anorectal malformation.
Select this code when the operative report supports construction by the abdominal route, rather than a perineal-only or combined abdominoperineal approach. Documentation should identify the congenital defect, the route used, and the reconstructive work performed. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 46735
- 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 RVU35.24 · 54%
- Practice expense (office) RVU20.52 · 31%
- Malpractice RVU9.42 · 14%
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.
46735 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
Choose 46735 when the reconstruction uses an abdominal approach; 46740 identifies a combined abdominal and perineal approach.
No office rate
This code is associated with repair of imperforate anus. Select based on the operative service documented, rather than assuming every congenital anorectal repair is 46735.
Compare 46735 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
Unavailable
Facility
$1929.09
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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 46735 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
5,618
- Code
- 46735
- Physician work
- 35.24
- Practice expense
- 20.52
- Malpractice
- 9.42
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 35.24 | × 1.000 | 35.2400 |
| Practice expense | 20.52 | × 0.915 | 18.7758 |
| Malpractice | 9.42 | × 0.397 | 3.7397 |
| Total RVUs | 57.7555 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$1929.09
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 35.24 | 1 |
| Practice expense | 20.52 | 0.915 |
| Malpractice | 9.42 | 0.397 |
(35.24 × 1 + 20.52 × 0.915 + 9.42 × 0.397) × $33.4009 = $1929.09
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.
46735 billing questions
How does this code differ from 46730?
46735 describes construction by an abdominal approach. Code 46730 is the perineal-approach sibling.
How does this code differ from 46740?
46735 is for the abdominal approach; 46740 is the combined abdominoperineal approach. Use the route documented for the reconstruction.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this procedure’s anatomy and descriptor.
What postoperative care is included?
The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What documentation supports code selection?
The operative report should establish the absent or imperforate anus, describe the reconstructive work, and identify the abdominal approach.
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.
5,61546715,,Rep perf anoper fistu,A,,7.43,7.18,NA,7.18,,1.98,16.59,16.59,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61646716,,Rep perf anoper/vestib fistu,A,,17.10,14.71,NA,14.71,,4.57,36.38,36.38,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61746730,,Construction of absent anus,A,,29.88,19.23,NA,19.23,,8.00,57.11,57.11,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61846735,,Construction of absent anus,A,,35.24,20.52,NA,20.52,,9.42,65.18,65.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61946740,,Construction of absent anus,A,,33.05,20.14,NA,20.14,,8.85,62.04,62.04,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62046742,,Repair of imperforated anus,A,,39.14,21.47,NA,21.47,,10.49,71.10,71.10,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,62146744,,Repair of cloacal anomaly,A,,57.47,26.06,NA,26.06,,15.39,98.92,98.92,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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