Billing code 46288: Anal fistula repairMedicare rate & RVUs in Ohio
Reports surgical closure of an anal fistula using an advancement flap, typically selected when the surgeon aims to close the internal opening while preserving sphincter function.
CMS doesn’t publish an office rate for 46288 in Ohio.
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 46288 covers
A colorectal surgeon repairs the fistula by mobilizing a flap of tissue to cover its internal opening. This approach may be selected for a tract whose anatomy or relationship to the anal sphincter makes laying it open undesirable. The operation is generally performed in an operating room, with the operative report identifying the tract, internal opening, flap tissue, and closure technique.
Report 46288 when the documented repair uses an advancement flap, not simply because an anal fistula is present. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery 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.
46288 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $531.04 |
How the 46288 rate is calculated
Each of 46288’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 · 46288
RVUs × geographic indexes × conversion factor
Work7.61
7.61 RVUs× 1.000 GPCI
Practice expense7.50
7.50 RVUs× 1.000 GPCI
Malpractice1.43
1.43 RVUs× 1.000 GPCI
Adjusted RVUs
16.5400
Conversion factor
$33.4009
Medicare rate
$552.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46288
46288 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46288
Anal fistula repair
| 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 · 46288
Anal fistula repair
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
46288 without 51 · national facility
$552.45
Anal fistula repair
46288-51 · Second procedure: 50%
$276.23
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%).
46288 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46280Anal fistula surgery
- 46280 describes treatment of a complex fistula by a different operative approach. Use 46288 when the surgeon performs an advancement-flap repair.
- 46285Anal fistula surgery
- 46285 describes fistula treatment performed in two stages. 46288 identifies repair using an advancement flap.
- 46707Fistula repair
- 46707 uses a fistula plug to close the tract; 46288 uses an advancement flap to cover the internal opening.
46288 billing questions
When is 46288 appropriate instead of a fistulotomy code?
Use 46288 when the operative method is an advancement-flap repair. Fistulotomy or fistulectomy codes describe different operative approaches, with code selection based on the procedure actually performed.
What documentation supports an advancement-flap repair?
The operative report should identify the fistula tract and internal opening and describe the tissue flap, its advancement, and how it was used to close the opening.
Can the surgeon report a fistulotomy or fistulectomy with 46288?
Do not report another fistula-treatment code just to describe steps integral to the flap repair. A separate code requires a distinct, separately reportable service supported by the operative documentation.
Does 46288 have a 90-day global period?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant-at-surgery modifier be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 46288.
How are other same-session procedures handled?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. Co-surgeons and team surgery are not permitted.
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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