Billing code 46280: Anal fistula surgeryMedicare rate & RVUs in Oregon
Reports operative treatment of an anal fistula involving a transsphincteric, suprasphincteric, or extrasphincteric tract, including seton placement when performed.
CMS doesn’t publish an office rate for 46280 in Oregon.
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 46280 covers
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.
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 46280 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $502.23 |
| Rest Of Oregon | Unavailable | $470.19 |
How the 46280 rate is calculated
Each of 46280’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 · 46280
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.23Practice expense 7.06Malpractice 1.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46280
46280 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46280
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 · 46280
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
46280 without 51 · national facility
$482.64
Anal fistula surgery
46280-51 · Second procedure: 50%
$241.32
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%).
46280 compared with similar codes
Compare codes
46280 vs 46270 vs 46275 vs 46285 vs 46288: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46270Anal fistula surgery
- 46270 is for a subcutaneous anal fistula. Use 46280 when the documented tract is transsphincteric, suprasphincteric, or extrasphincteric.
- 46275Fistula surgery
- 46275 is for an intersphincteric tract; 46280 is for the specified more complex tract courses through or around the sphincter complex.
- 46285Anal fistula surgery
- 46285 describes a two-stage fistulotomy. 46280 applies to the complex tract treatment described for this code, including seton placement when performed.
- 46288Anal fistula repair
- 46288 describes fistula repair. Choose between it and 46280 based on the operative treatment documented, not merely the presence of an anal fistula.
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 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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