No office rate
This code addresses a perineal anorectal fistula. Choose 46716 when the operative documentation identifies the vestibular fistula anatomy associated with that code.
On this page
CMS RVU26D · Effective 2026-10-01
46715 Fistula repair Medicare reimbursement rates in Nebraska
Reports surgical repair of a perineal anorectal fistula, typically associated with a congenital anorectal malformation and treated by a colorectal or pediatric surgeon. Compare 46715 office and facility rates across CMS payment localities in Nebraska.
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 46715 in Nebraska?
Nebraska 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
$494.52
1 of 1 localities have a supported rate.
Payment area: Nebraska
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 46715: Perineal anorectal fistula repair
Reports surgical repair of a perineal anorectal fistula, typically associated with a congenital anorectal malformation and treated by a colorectal or pediatric surgeon.
This service repairs a fistulous connection between the anorectal tract and the perineal skin. It is most often performed for a congenital anorectal malformation, commonly in a pediatric patient, by a pediatric surgeon or colorectal surgeon in an operating room. The surgeon identifies and separates the tract and reconstructs the anorectal opening as needed to establish the intended anatomy.
Select the code when the operative report documents repair of a perineal anorectal fistula; the fistula’s anatomy and the procedure performed should support that choice. Distinguish a vestibular fistula, which is addressed by a neighboring code. CMS assigns a 90-day global period, including the day-before preoperative visit and 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 multiple procedure reduction. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery payment may be allowed; co-surgeons and team surgery are not permitted.
CMS billing rules for 46715
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.43 · 45%
- Practice expense (office) RVU7.18 · 43%
- Malpractice RVU1.98 · 12%
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.
46715 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
46706 describes treatment of an anal fistula with fibrin glue. This code is for surgical repair of a perineal anorectal fistula, not glue treatment.
No office rate
46707 is a plug-based anorectal fistula repair. Use this code for the perineal anorectal fistula repair documented in the operative report, not a plug procedure.
Compare 46715 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$494.52
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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 46715 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,615
- Code
- 46715
- Physician work
- 7.43
- Practice expense
- 7.18
- Malpractice
- 1.98
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.43 | × 1.000 | 7.4300 |
| Practice expense | 7.18 | × 0.923 | 6.6271 |
| Malpractice | 1.98 | × 0.378 | 0.7484 |
| Total RVUs | 14.8056 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$494.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.43 | 1 |
| Practice expense | 7.18 | 0.923 |
| Malpractice | 1.98 | 0.378 |
(7.43 × 1 + 7.18 × 0.923 + 1.98 × 0.378) × $33.4009 = $494.52
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.
46715 billing questions
How is this code distinguished from 46716?
Use this code for repair of a perineal anorectal fistula. Code 46716 is the nearby choice when the documented anatomy includes a vestibular fistula.
Does the 90-day global period include postoperative visits?
Yes. Related postoperative care for 90 days is included, along with the day-before preoperative visit.
Can modifier 50 be used for a fistula on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code’s descriptor and anatomy.
May an assistant surgeon be reported?
Assistant-at-surgery payment may be available. CMS does not permit co-surgeons or team surgery for this code.
What documentation supports choosing this code?
The operative report should identify the perineal anorectal fistula, describe its anatomy, and document the repair performed. Include enough detail to distinguish it from a vestibular fistula or a different fistula-treatment method.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard multiple procedure reduction to the other procedures in that session.
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.
5,61246707,,Repair anorectal fist w/plug,A,,6.23,7.48,NA,7.48,,1.66,15.37,15.37,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61346710,,Repr per/vag pouch sngl proc,A,,16.71,10.80,NA,10.80,,4.46,31.97,31.97,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61446712,,Repr per/vag pouch dbl proc,A,,35.54,17.12,NA,17.12,,9.52,62.18,62.18,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,61546715,,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
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068