$497.35–$552.86
This code includes fissure excision and may include sphincterotomy. Report 46080 when sphincter division is the service, not when it is included in the fissurectomy.
On this page
CMS RVU26D · Effective 2026-10-01
46080 Anal sphincterotomy Medicare reimbursement rates in Pennsylvania
Reports surgical division of the anal sphincter, commonly to treat a chronic anal fissure when sphincterotomy is the performed procedure. Compare 46080 office and facility rates across CMS payment localities in Pennsylvania.
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 46080 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$296.94–$329.18
2 of 2 localities have a supported rate.
Facility setting
$144.85–$156.72
2 of 2 localities have a supported rate.
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.
Anorectal surgery
About 46080: Anal sphincterotomy for sphincter division
Reports surgical division of the anal sphincter, commonly to treat a chronic anal fissure when sphincterotomy is the performed procedure.
This procedure divides anal sphincter muscle, most often the internal sphincter in a lateral sphincterotomy for a chronic anal fissure. A colorectal or general surgeon typically performs it in an operating room or outpatient surgical facility. The operative note should identify the indication and describe the sphincter division performed.
Report 46080 when sphincterotomy itself is the service. If the surgeon excises the fissure and performs sphincterotomy as part of that operation, report 46200 rather than separately reporting 46080 for the included sphincterotomy. The 10-day global period includes related postoperative visits 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 46080
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.46 · 26%
- Practice expense (office) RVU6.50 · 69%
- Malpractice RVU0.49 · 5%
498
Medicare services in 2024 · #3566 by national volume
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.
46080 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
46045 reports transanal drainage of an anorectal abscess under anesthesia; 46080 divides sphincter muscle and is not an abscess-drainage code.
$248.83–$278.45
46050 is for drainage of a superficial perianal abscess. Choose 46080 for sphincter division, not for incision and drainage of a superficial abscess.
No office rate
46070 treats an anal septum in an infant. It is not the sphincter-division procedure reported with 46080.
Compare 46080 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$329.18
Facility
$156.72
Rest Of Pennsylvania →
Office / nonfacility
$296.94
Facility
$144.85
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46080 billing questions
When should 46080 be reported instead of 46200?
Report 46080 when the service is sphincter division. Use 46200 when the surgeon performs fissurectomy and includes sphincterotomy in that operation; do not separately report 46080 for the included division.
What documentation supports 46080?
Document the indication, the sphincter muscle divided, and the operative technique. For a fissure, the note should make clear that sphincterotomy was performed rather than only an examination or another anorectal procedure.
Can modifier 50 be used for bilateral sphincterotomy?
No. The CMS bilateral adjustment does not apply to 46080, and modifier 50 is inappropriate for this code.
Are postoperative visits separately reportable during the global period?
Related postoperative visits for 10 days are included in the procedure's global period.
How does the multiple-procedure rule affect 46080?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 46080. 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 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.
5,57446050,,I&d perianal abscess supfc,A,,1.21,6.55,,1.65,,0.24,8.00,3.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57546060,,I&d ischiorectal/ntrmrl absc,A,,6.21,7.31,NA,7.31,,1.20,14.72,14.72,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57646070,,Incision anal septum infant,A,,2.72,5.23,NA,5.23,,0.72,8.67,8.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57746080,,Sphnctrotmy anal div sphnctr,A,,2.46,6.50,,1.54,,0.49,9.45,4.49,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57846083,,Inc thrombosed hroid xtrnl,A,,1.41,5.06,,1.53,,0.28,6.75,3.22,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57946200,,Removal of anal fissure,A,,3.50,11.79,,6.31,,0.60,15.89,10.41,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58046220,,Excise anal ext tag/papilla,A,,1.57,6.39,,1.72,,0.29,8.25,3.58,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00