Billing code 46200: Fissure surgeryMedicare rate & RVUs in Texas
Reports operative removal of diseased anal fissure tissue, including sphincterotomy when performed, when the fissure is treated surgically.
Medicare pays $493.88–$551.53 for 46200 in the office in Texas, from Beaumont to Austin. 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 46200 covers
The surgeon removes diseased tissue from an anal fissure; sphincterotomy is included when performed as part of the operation. Colorectal and general surgeons typically perform this procedure in an operating room under anesthesia for a fissure requiring surgical treatment. The operative report should identify the fissure and describe the excision and any sphincter work performed.
Select this code when the fissure itself is excised. When hemorrhoidectomy and fissure treatment are performed together, consider the combined hemorrhoidectomy-and-fissure codes 46257 or 46261 according to the hemorrhoid groups treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and reduces other procedures to 50%. Modifier 50 is inappropriate for this anatomy. Medicare does not pay an assistant at surgery; 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 46200 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$493.88 to $551.53
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $551.53 | $357.88 |
| Beaumont | $493.88 | $327.31 |
| Brazoria | $523.72 | $342.33 |
| Dallas | $527.37 | $345.07 |
| Fort Worth | $523.69 | $343.22 |
| Galveston | $525.47 | $343.72 |
| Houston | $536.45 | $354.70 |
| Rest Of Texas | $508.71 | $335.01 |
How the 46200 rate is calculated
Each of 46200’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 · 46200
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.50Practice expense 11.79Malpractice 0.60
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46200
46200 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46200
Fissure 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 · 46200
Fissure 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
46200 without 51 · national office
$530.74
Fissure surgery
46200-51 · Second procedure: 50%
$265.37
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%).
46200 compared with similar codes
Compare codes
46200 vs 46257 vs 46261 vs 46220 vs 46230: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46257Hemorrhoidectomy
- Use this combined code when fissure treatment accompanies hemorrhoidectomy for one internal or external hemorrhoid group; 46200 describes fissure excision without that combined service.
- 46261Hemorrhoidectomy
- This combined code describes fissure treatment with hemorrhoidectomy for two or more groups. Choose 46200 when the operative service is fissure excision without that hemorrhoidectomy.
- 46220Anal tag excision
- This code targets an anal papilla, not the fissure. Choose 46200 when the surgeon excises diseased fissure tissue.
- 46230Anal tag excision
- This code targets anal tags. It is not a substitute for fissure excision when the operative target is the fissure.
46200 billing questions
When should 46200 be reported instead of 46257 or 46261?
Report 46200 when the operation excises the fissure without the qualifying hemorrhoidectomy described by a combined code. Codes 46257 and 46261 combine fissure treatment with hemorrhoidectomy for the specified hemorrhoid groups.
Is sphincterotomy separately reported with 46200?
Sphincterotomy performed as part of the fissure operation is included in 46200. The operative report should document the work performed.
Does modifier 50 apply to 46200?
No. The anal anatomy and service are not reported bilaterally, so modifier 50 is inappropriate.
How does the 90-day global period affect postoperative visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are not separately reported as routine postoperative visits.
What happens when another procedure is performed in the same session?
Medicare pays the highest-valued procedure in full and reduces the other procedure or procedures to 50%. An assistant at surgery is not paid, and 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
Fee sheets
Put 46200 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →