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See a sample rate comparisonCPT 46030 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Rectal Surgery, Surgery To Close Off An Abnormal Passageway (Fistula). This Is A Two-Stage Procedure. First A Type Of Gauze Is Placed In The Rectum To Mark And Surround The Fistula. The Gauze Is Pulled Tight Gradually Until The Fistula Is Closed.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | None 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46030 |
| Medicaid Fee Schedule | View Medicaid rates for 46030 |
National average reimbursement for CPT 46030 by major payers:
$224.11
$188.54
$271.50
$157.77
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CPT 46030
5 of 25 sample ratesHigher to lower in this preview
Ambulatory Surgery Center Group Ltd
$5,532.00Published rateBaylor Scott & White Surgicare Waxahachie LLC
$2,172.00Published rateUm Shore Regional Health Surgery Center At Cambridge, LLC, Um Shore Regional Health Surgery Center At Cambridge
$773.00Published ratePiney Orchard Surgery Center, LLC.
Piney Orchard Surgery Center
$644.00Published rateAnna Boone
Deaconess Hospital Inc
$113.22Published rate
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See a sample payer proposalCPT 46030 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46030 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 46030 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 45999-CPT | Moderate | Unlisted Procedure Rectum |
| 46020-CPT | Moderate | Rectal Surgery, Surgery To Close Off An Abnormal Passageway (Fistula). This Is A Two-Stage Procedure. First A Type Of Gauze Is Placed In The Rectum To Mark And Surround The Fistula. The Gauze Is Pulled Tight Gradually Until The Fistula Is Closed. |
| 46030-CPT | Moderate | Rectal Surgery, Surgery To Close Off An Abnormal Passageway (Fistula). This Is A Two-Stage Procedure. First A Type Of Gauze Is Placed In The Rectum To Mark And Surround The Fistula. The Gauze Is Pulled Tight Gradually Until The Fistula Is Closed. |
| 46040-CPT | Moderate | Ncision & Drain Of Ischiorectal &/Or Perirectal Absces (Separ, Incision And Drainage Of Ischiorectal And/Or Perirectal Abscess (Separ |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46030. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46030 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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