Billing code 46045: Abscess drainageMedicare rate & RVUs in Washington
Reports operative drainage of a perirectal abscess under anesthesia when the collection requires surgical access beyond superficial bedside drainage.
CMS doesn’t publish an office rate for 46045 in Washington.
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 46045 covers
A surgeon, commonly a colorectal or general surgeon, opens and drains a perirectal abscess in an operative setting with anesthesia. The service is used for a collection requiring operative access rather than drainage of a superficial perianal abscess. The operative note should identify the abscess location and document the drainage performed.
Select this code when the documented service is perirectal abscess drainage under anesthesia; use the abscess site and the procedure performed to distinguish it from nearby drainage codes. This major surgery has 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, Medicare pays the highest-valued procedure in full and other procedures at 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and 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 46045 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $451.46 |
| Seattle (King Cnty) | Unavailable | $498.24 |
How the 46045 rate is calculated
Each of 46045’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 · 46045
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.72Practice expense 6.43Malpractice 1.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46045
46045 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46045
Abscess drainage
| 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 · 46045
Abscess drainage
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
46045 without 51 · national facility
$447.57
Abscess drainage
46045-51 · Second procedure: 50%
$223.79
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%).
46045 compared with similar codes
Compare codes
46045 vs 46040 vs 46050 vs 46060: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46040Abscess drainage
- Both concern abscess drainage in the ischiorectal or perirectal region. Choose based on the precise service and abscess documented; 46045 specifically represents perirectal drainage under anesthesia.
- 46050Perianal abscess drainage
- 46050 is for a superficial perianal abscess. This code describes drainage of a perirectal abscess under anesthesia.
- 46060Abscess drainage
- 46060 includes treatment of an associated fistula by fistulectomy or fistulotomy along with abscess drainage. This code represents perirectal abscess drainage under anesthesia without that combined fistula procedure.
46045 billing questions
How is this distinguished from 46040?
Use 46045 for documented perirectal abscess drainage under anesthesia. Select 46040 when the documented drainage service and abscess type fit that code instead.
When is 46050 a better fit?
46050 describes drainage of a superficial perianal abscess. This code is for perirectal abscess drainage under anesthesia, not a superficial perianal collection.
Should 46060 be reported when a fistula is treated?
46060 describes abscess drainage performed with fistulectomy or fistulotomy. Review the operative report to determine whether that fistula procedure was performed rather than reporting drainage alone.
What documentation supports this code?
Document the perirectal location, the abscess drainage performed, and that the service was carried out under anesthesia. The operative report should distinguish the collection from a superficial perianal abscess.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.
How does the global period affect postoperative billing?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, Medicare applies the standard multiple-procedure reduction.
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 46045 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 →