Billing code 46942: Anal fissure treatmentMedicare rate & RVUs in Oregon
Report 46942 for a subsequent procedural treatment of an anal fissure, rather than the initial treatment or a routine postoperative visit.
Medicare pays $274.22–$298.78 for 46942 in the office in Oregon, from Rest Of Oregon to Portland. 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 46942 covers
Code 46942 represents a subsequent procedural treatment directed at an anal fissure. It is used by clinicians such as colorectal surgeons and general surgeons when the fissure requires further active treatment after an initial treatment. The service addresses the fissure itself; it is not simply an office assessment of persistent pain, bleeding, or healing. A routine follow-up visit within the postoperative period is included in the original procedure’s global care.
Choose this code when documentation supports subsequent treatment, not the initial fissure treatment reported with 46940. The record should identify the fissure and explain the further treatment performed. CMS assigns a 10-day global period, so related postoperative visits during that period are included. 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 requires documented medical necessity; 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 46942 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $298.78 | $127.34 |
| Rest Of Oregon | $274.22 | $120.52 |
How the 46942 rate is calculated
Each of 46942’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 · 46942
RVUs × geographic indexes × conversion factor
Work2.02
2.02 RVUs× 1.000 GPCI
Practice expense6.01
6.01 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
8.3200
Conversion factor
$33.4009
Medicare rate
$277.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46942
46942 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46942
Anal fissure treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46942
Anal fissure treatment
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46942 without 51 · national office
$277.90
Anal fissure treatment
46942-51 · Second procedure: 50%
$138.95
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%).
46942 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46940Anal fissure treatment
- Use 46940 for initial anal fissure treatment and 46942 for subsequent treatment. The treatment stage, not simply a follow-up date, distinguishes them.
- 46080Anal sphincterotomy
- 46080 identifies an incision of the anal sphincter for fissure treatment. Use it when that specific procedure is performed, rather than selecting 46942 solely because a fissure is present.
- 46505Anal chemodenervation
- 46505 describes injection into the anal sphincter. It represents an injection procedure, not subsequent fissure treatment as coded by 46942.
46942 billing questions
How does 46942 differ from 46940?
46942 is for subsequent treatment of an anal fissure; 46940 is for initial treatment. The record should support which treatment stage occurred.
Can 46942 be reported for a postoperative check?
No. A routine related postoperative visit during the 10-day global period is included; 46942 represents further active treatment.
Should modifier 50 be appended?
No. Modifier 50 is inappropriate for this code.
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.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is available only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What documentation supports 46942?
Document the anal fissure, the subsequent treatment performed, and why the encounter represents further treatment rather than initial treatment or routine follow-up.
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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