No office rate
Choose this code when the operative service is anal sphincter dilation under anesthesia. Use 46070 when the surgeon incises an anal septum in an infant.
On this page
CMS RVU26D · Effective 2026-10-01
46070 Anal septum incision Medicare reimbursement rates in Rhode Island
Reports surgical incision of an obstructing anal septum in an infant to open the anal outlet, rather than drainage of an abscess or fissure treatment. Compare 46070 office and facility rates across CMS payment localities in Rhode Island.
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 46070 in Rhode Island?
Rhode Island 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
$294.48
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Anorectal surgery
About 46070: Infant anal septum incision
Reports surgical incision of an obstructing anal septum in an infant to open the anal outlet, rather than drainage of an abscess or fissure treatment.
A surgeon incises a thin septum obstructing the anal outlet in an infant, typically to correct a congenital outlet abnormality. The procedure is performed in an operative setting by a pediatric surgeon or colorectal surgeon. It is distinct from draining a perianal or deeper anorectal abscess and from operating on the anal sphincter for a fissure.
Report the code when the operative note documents incision of the anal septum in an infant; the diagnosis and findings should support that specific anatomy and procedure. CMS 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 multiple procedure reduction. Modifier 50 is inappropriate for this procedure. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 46070
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.72 · 31%
- Practice expense (office) RVU5.23 · 60%
- Malpractice RVU0.72 · 8%
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.
46070 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$322.60
46080 is for sphincterotomy to treat an anal fissure. It does not describe incision of an infant's anal septum.
No office rate
46045 describes transanal drainage of an anorectal abscess under anesthesia. It is not used for incision of a congenital anal septum.
Compare 46070 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$294.48
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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 46070 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
5,576
- Code
- 46070
- Physician work
- 2.72
- Practice expense
- 5.23
- Malpractice
- 0.72
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.72 | × 1.019 | 2.7717 |
| Practice expense | 5.23 | × 1.033 | 5.4026 |
| Malpractice | 0.72 | × 0.892 | 0.6422 |
| Total RVUs | 8.8165 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$294.48
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.72 | 1.019 |
| Practice expense | 5.23 | 1.033 |
| Malpractice | 0.72 | 0.892 |
(2.72 × 1.019 + 5.23 × 1.033 + 0.72 × 0.892) × $33.4009 = $294.48
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.
46070 billing questions
How is this different from anal sphincter dilation?
This code is for incision of an anal septum in an infant. Dilation is a different approach for anal narrowing and should be selected when the documented procedure is dilation rather than septum incision.
Can an anorectal examination under anesthesia be billed separately?
The operative report should clarify whether the service was a diagnostic examination alone or the examination was part of the septum procedure. Do not treat the examination as a separate service solely because it is documented.
Does this code have a 90-day global period?
Yes. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this procedure.
When is an assistant at surgery payable?
CMS permits assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session handled?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same 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.
5,57346045,,I&d absc tranal under anes,A,,5.72,6.43,NA,6.43,,1.25,13.40,13.40,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57446050,,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537