Billing code 46748: Cloacal repairMedicare rate & RVUs in Washington
Reports definitive reconstruction of a congenital cloacal anomaly when the surgeon uses both abdominal and perineal approaches during the repair.
CMS doesn’t publish an office rate for 46748 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 46748 covers
A cloacal anomaly is a congenital malformation in which the urinary, genital, and intestinal tracts share a common outlet. This service covers complex reconstruction using both abdominal and perineal access to separate or reconstruct the involved pathways. It is generally performed in a hospital operating room by a pediatric surgeon with expertise in congenital pelvic reconstruction. The operative report should establish the anomaly and document the use of both approaches as part of the repair.
Choose this code when the repair uses both abdominal and perineal approaches; codes 46744 and 46746 describe repairs using a single approach. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. If other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is 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 46748 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $3,855.93 |
| Seattle (King Cnty) | Unavailable | $4,146.39 |
How the 46748 rate is calculated
Each of 46748’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 · 46748
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 69.63Practice expense 29.17Malpractice 18.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46748
46748 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46748
Cloacal 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 46748
Cloacal 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
46748 without 51 · national facility
$3,922.94
Cloacal repair
46748-51 · Second procedure: 50%
$1,961.47
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%).
46748 compared with similar codes
Compare codes
46748 vs 46744 vs 46746 vs 46742: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46744Cloacal repair
- Use 46744 when the cloacal repair is performed through a perineal approach alone; 46748 represents a combined abdominal and perineal repair.
- 46746Cloacal repair
- Use 46746 for cloacal repair through an abdominal approach alone. The combined abdominal and perineal approach distinguishes 46748.
- 46742Anorectal repair
- 46742 addresses repair of an imperforate anus. Use 46748 for reconstruction of a cloacal anomaly involving a shared outlet and both surgical approaches.
46748 billing questions
When should I report 46748 instead of 46744 or 46746?
Report 46748 when the cloacal repair uses both abdominal and perineal approaches. The single-approach alternatives are 46744 and 46746.
Does the 90-day global period include routine postoperative visits?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to this anatomy, so modifier 50 is inappropriate.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How does payment change when other procedures are performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
What documentation supports choosing this code?
Document the cloacal anomaly, the reconstruction performed, and use of both abdominal and perineal approaches.
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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