Billing code 46707: Fistula repairMedicare rate & RVUs in Virginia
Reports operative repair of an anorectal fistula by placing a plug in the tract, rather than using glue or cutting open the tract.
CMS doesn’t publish an office rate for 46707 in Virginia.
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 46707 covers
A colorectal or general surgeon uses this repair to treat an anorectal fistula by placing a plug within the fistula tract. The plug approach closes the tract while avoiding a cutting fistulotomy. The procedure is typically performed in an operating facility, where the surgeon can identify the tract and position the plug.
Select this code when the operative report documents placement of a fistula plug, rather than injection of glue or a fistulotomy. Document the tract treated and the material placed; preparing the tract and positioning the plug are steps of the repair, not additional plug repairs. Medicare treats this as major surgery: the day-before preoperative visit and 90 days of related postoperative care are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this anatomy. An assistant surgeon is paid only when medical necessity is documented; 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 46707 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $575.35 |
| Virginia | Unavailable | $492.82 |
How the 46707 rate is calculated
Each of 46707’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 · 46707
RVUs × geographic indexes × conversion factor
Work6.23
6.23 RVUs× 1.000 GPCI
Practice expense7.48
7.48 RVUs× 1.000 GPCI
Malpractice1.66
1.66 RVUs× 1.000 GPCI
Adjusted RVUs
15.3700
Conversion factor
$33.4009
Medicare rate
$513.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46707
46707 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46707
Fistula repair
| 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) | 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46707
Fistula repair
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
46707 without 51 · national facility
$513.37
Fistula repair
46707-51 · Second procedure: 50%
$256.69
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%).
46707 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46706Fistula repair
- Both address an anorectal fistula without describing a cutting fistulotomy. Choose 46707 for a plug placed in the tract and 46706 for glue.
- 46270Anal fistula surgery
- Code 46270 describes surgical opening or removal of a subcutaneous anal fistula tract. Choose 46707 when the documented repair uses a plug.
- 46275Fistula surgery
- Code 46275 describes surgical opening or removal of an intersphincteric anal fistula tract. Code 46707 identifies repair by plug placement rather than that cutting approach.
46707 billing questions
When is 46707 reported instead of 46706?
Report 46707 when the surgeon places a plug in the anorectal fistula tract. Code 46706 describes repair using glue instead.
Is tract preparation separately reported from plug placement?
Preparing the fistula tract and positioning the plug are part of the plug repair. The operative report should establish that a plug was placed.
What postoperative care is included?
The code has a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How does Medicare pay this repair when another procedure is performed in the same session?
The standard multiple-procedure reduction applies: the highest-valued procedure is paid in full and other procedures at 50%.
Should modifier 50 be used for two fistula tracts?
No. The bilateral adjustment does not apply to this anorectal repair, and modifier 50 is inappropriate.
Can another surgeon assist with the plug repair?
An assistant at surgery is paid only with documentation of medical necessity. Medicare does not permit co-surgeons or team surgery for this code.
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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