No office rate
Both codes address construction for an absent anus, but represent distinct operative variants. Use the code that matches the approach and work documented.
On this page
CMS RVU26D · Effective 2026-10-01
46740 Anoplasty Medicare reimbursement rates in Kentucky
Reports operative creation of an anal outlet for a congenital absent-anus anomaly, with code selection guided by the reconstruction performed. Compare 46740 office and facility rates across CMS payment localities in Kentucky.
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 46740 in Kentucky?
Kentucky 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
$1972.40
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 46740: Congenital absent-anus construction
Reports operative creation of an anal outlet for a congenital absent-anus anomaly, with code selection guided by the reconstruction performed.
A surgeon creates an anal outlet when a patient is born without a normally formed anal opening, as part of treatment for a congenital anorectal malformation. These complex reconstructions are commonly performed by pediatric surgeons or colorectal surgeons in a hospital operating room. The specific operation may involve mobilizing the rectum and establishing its connection to the new outlet; the operative report should describe the anatomy and reconstruction performed.
Choose this code only when the documented operation matches this absent-anus construction service, rather than a repair of an existing anal opening or a different anorectal anomaly procedure. Document the congenital anatomy, operative approach, and steps used to create the outlet. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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 anatomy. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 46740
- 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 RVU33.05 · 53%
- Practice expense (office) RVU20.14 · 32%
- Malpractice RVU8.85 · 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.
46740 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
This is another absent-anus construction family code. Distinguish it from 46740 by the specific operation documented, not simply by the congenital diagnosis.
No office rate
46742 is for repair of an imperforate anus. Use 46740 when the documented service is construction of an anal outlet for an absent-anus anomaly.
Compare 46740 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$1972.40
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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 46740 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
5,619
- Code
- 46740
- Physician work
- 33.05
- Practice expense
- 20.14
- Malpractice
- 8.85
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 33.05 | × 1.000 | 33.0500 |
| Practice expense | 20.14 | × 0.889 | 17.9045 |
| Malpractice | 8.85 | × 0.915 | 8.0977 |
| Total RVUs | 59.0522 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$1972.40
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 33.05 | 1 |
| Practice expense | 20.14 | 0.889 |
| Malpractice | 8.85 | 0.915 |
(33.05 × 1 + 20.14 × 0.889 + 8.85 × 0.915) × $33.4009 = $1972.40
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.
46740 billing questions
How does 46740 differ from 46730 or 46735?
These codes are in the absent-anus construction family. Select the code matching the operation and approach documented in the operative report; do not choose by diagnosis alone.
Can routine postoperative visits be billed separately during the global period?
Related postoperative care through the 90-day global period is included, as is the day-before preoperative visit.
Should modifier 50 be appended for a bilateral reconstruction?
No. Modifier 50 is inappropriate for this service and anatomy.
Can an assistant surgeon be reported?
CMS indicates that assistant-at-surgery payment may be made for this code. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple-procedure reduction.
What documentation supports reporting 46740?
Record the congenital anorectal anatomy and the operative details showing construction of an anal outlet, including the approach and reconstruction performed.
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.
5,61646716,,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
5,62246746,,Repair of cloacal anomaly,A,,63.80,27.76,NA,27.76,,17.08,108.64,108.64,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631