Billing code 46285: Anal fistula surgeryMedicare rate & RVUs in Maine
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.
Medicare pays $584.72–$614.95 for 46285 in the office in Maine, from Rest Of Maine to Southern Maine. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 46285 covers
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.
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.
Where 46285 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | $584.72 | $396.97 |
| Southern Maine | $614.95 | $412.70 |
How the 46285 rate is calculated
Each of 46285’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46285
RVUs × geographic indexes × conversion factor
Work5.28
5.28 RVUs× 1.000 GPCI
Practice expense12.62
12.62 RVUs× 1.000 GPCI
Malpractice0.99
0.99 RVUs× 1.000 GPCI
Adjusted RVUs
18.8900
Conversion factor
$33.4009
Medicare rate
$630.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46285
46285 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46285
Anal fistula surgery
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46285
Anal fistula surgery
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46285 without 51 · national office
$630.94
Anal fistula surgery
46285-51 · Second procedure: 50%
$315.47
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
46285 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46270Anal fistula surgery
- 46270 is for a subcutaneous fistula treatment. Choose 46285 when the procedure is staged and includes seton placement.
- 46275Fistula surgery
- 46275 identifies treatment of an intersphincteric fistula; 46285 identifies staged treatment with a seton.
- 46280Anal fistula surgery
- 46280 is used for specified complex fistula anatomy. 46285 is distinguished by the staged seton approach.
- 46288Anal fistula repair
- 46288 represents anal fistula repair, while 46285 is for staged treatment with seton placement.
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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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