No office rate
46280 describes treatment of a complex fistula by a different operative approach. Use 46288 when the surgeon performs an advancement-flap repair.
On this page
CMS RVU26D · Effective 2026-10-01
46288 Anal fistula repair Medicare reimbursement rates in Wyoming
Reports surgical closure of an anal fistula using an advancement flap, typically selected when the surgeon aims to close the internal opening while preserving sphincter function. Compare 46288 office and facility rates across CMS payment localities in Wyoming.
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 46288 in Wyoming?
Wyoming 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
$540.03
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Colorectal surgery
About 46288: Anal fistula repair with advancement flap
Reports surgical closure of an anal fistula using an advancement flap, typically selected when the surgeon aims to close the internal opening while preserving sphincter function.
A colorectal surgeon repairs the fistula by mobilizing a flap of tissue to cover its internal opening. This approach may be selected for a tract whose anatomy or relationship to the anal sphincter makes laying it open undesirable. The operation is generally performed in an operating room, with the operative report identifying the tract, internal opening, flap tissue, and closure technique.
Report 46288 when the documented repair uses an advancement flap, not simply because an anal fistula is present. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 46288
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.61 · 46%
- Practice expense (office) RVU7.50 · 45%
- Malpractice RVU1.43 · 9%
286
Medicare services in 2024 · #4029 by national volume
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.
46288 compared with similar codes
Office rates for Wyoming, from the same CMS release.
$622.35
46285 describes fistula treatment performed in two stages. 46288 identifies repair using an advancement flap.
No office rate
46707 uses a fistula plug to close the tract; 46288 uses an advancement flap to cover the internal opening.
Compare 46288 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$540.03
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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 46288 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,594
- Code
- 46288
- Physician work
- 7.61
- Practice expense
- 7.50
- Malpractice
- 1.43
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.61 | × 1.000 | 7.6100 |
| Practice expense | 7.50 | × 1.000 | 7.5000 |
| Malpractice | 1.43 | × 0.740 | 1.0582 |
| Total RVUs | 16.1682 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$540.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.61 | 1 |
| Practice expense | 7.5 | 1 |
| Malpractice | 1.43 | 0.74 |
(7.61 × 1 + 7.5 × 1 + 1.43 × 0.74) × $33.4009 = $540.03
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.
46288 billing questions
When is 46288 appropriate instead of a fistulotomy code?
Use 46288 when the operative method is an advancement-flap repair. Fistulotomy or fistulectomy codes describe different operative approaches, with code selection based on the procedure actually performed.
What documentation supports an advancement-flap repair?
The operative report should identify the fistula tract and internal opening and describe the tissue flap, its advancement, and how it was used to close the opening.
Can the surgeon report a fistulotomy or fistulectomy with 46288?
Do not report another fistula-treatment code just to describe steps integral to the flap repair. A separate code requires a distinct, separately reportable service supported by the operative documentation.
Does 46288 have a 90-day global period?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 or an assistant-at-surgery modifier be reported?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for 46288.
How are other same-session procedures handled?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction. 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 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.
5,59146275,,Remove anal fist inter,A,,5.28,12.62,,6.47,,0.98,18.88,12.73,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59246280,,Remove anal fist complex,A,,6.23,7.06,NA,7.06,,1.16,14.45,14.45,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59346285,,Remove anal fist 2 stage,A,,5.28,12.62,,6.51,,0.99,18.89,12.78,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59446288,,Repair anal fistula,A,,7.61,7.50,NA,7.50,,1.43,16.54,16.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59546320,,Removal of hemorrhoid clot,A,,1.60,5.08,,1.36,,0.28,6.96,3.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59646500,,Injection into hemorrhoid(s),A,,1.70,8.75,,3.85,,0.27,10.72,5.82,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59746505,,Chemodenervation anal musc,A,,3.10,6.61,,3.73,,0.55,10.26,7.38,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,