$544.46
46270 is for a subcutaneous anal fistula. Use 46280 when the documented tract is transsphincteric, suprasphincteric, or extrasphincteric.
On this page
CMS RVU26D · Effective 2026-10-01
46280 Anal fistula surgery Medicare reimbursement rates in Kansas
Reports operative treatment of an anal fistula involving a transsphincteric, suprasphincteric, or extrasphincteric tract, including seton placement when performed. Compare 46280 office and facility rates across CMS payment localities in Kansas.
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 46280 in Kansas?
Kansas 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
$440.79
1 of 1 localities have a supported rate.
Payment area: Kansas
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 46280: Complex anal fistula surgery
Reports operative treatment of an anal fistula involving a transsphincteric, suprasphincteric, or extrasphincteric tract, including seton placement when performed.
A colorectal or general surgeon uses this code to treat an anal fistula whose tract passes through or around the sphincter complex, such as a transsphincteric, suprasphincteric, or extrasphincteric tract. The operation addresses the fistula tract; a seton may be placed as part of that treatment. These procedures are commonly performed in an operating room, with the exact approach guided by the tract’s course and its relationship to the sphincter muscles.
Select the code from the documented fistula anatomy and operative treatment, not simply from a label such as “complex.” The operative report should identify the tract’s course and describe the treatment performed, including seton placement when applicable. Seton placement is included in this service when performed. Medicare assigns a 90-day global period, including 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; assistant-at-surgery payment is restricted, and co-surgeons and team surgery are not permitted.
CMS billing rules for 46280
- 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 RVU6.23 · 43%
- Practice expense (office) RVU7.06 · 49%
- Malpractice RVU1.16 · 8%
1.3K
Medicare services in 2024 · #2785 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.
46280 compared with similar codes
Office rates for Kansas, from the same CMS release.
$573.91
46275 is for an intersphincteric tract; 46280 is for the specified more complex tract courses through or around the sphincter complex.
$574.08
46285 describes a two-stage fistulotomy. 46280 applies to the complex tract treatment described for this code, including seton placement when performed.
No office rate
46288 describes fistula repair. Choose between it and 46280 based on the operative treatment documented, not merely the presence of an anal fistula.
Compare 46280 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
Kansas →
Office / nonfacility
Unavailable
Facility
$440.79
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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 46280 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
5,592
- Code
- 46280
- Physician work
- 6.23
- Practice expense
- 7.06
- Malpractice
- 1.16
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.23 | × 1.000 | 6.2300 |
| Practice expense | 7.06 | × 0.904 | 6.3822 |
| Malpractice | 1.16 | × 0.504 | 0.5846 |
| Total RVUs | 13.1969 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$440.79
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.23 | 1 |
| Practice expense | 7.06 | 0.904 |
| Malpractice | 1.16 | 0.504 |
(6.23 × 1 + 7.06 × 0.904 + 1.16 × 0.504) × $33.4009 = $440.79
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.
46280 billing questions
How is 46280 distinguished from 46275?
46280 is for a transsphincteric, suprasphincteric, or extrasphincteric tract. 46275 describes treatment of an intersphincteric fistula.
Can seton placement be billed separately?
Seton placement is included in 46280 when performed as part of the fistula treatment.
What documentation supports reporting 46280?
The operative report should describe the fistula tract’s course, its relationship to the sphincter muscles, and the surgical treatment performed.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code because of its descriptor or anatomy.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple procedure reduction.
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.
5,58946262,,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
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
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958