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See a sample rate comparisonCPT 46200 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.
Surgery Anal Tissue Repair, Surgery To Repair A Fissure (Deep Crack) In The Tissues. The Procedure May Include Removing A Portion Of The Sphincter Muscle.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46200 |
| Medicaid Fee Schedule | View Medicaid rates for 46200 |
National average reimbursement for CPT 46200 by major payers:
$539.99
$569.26
$631.02
$542.90
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CPT 46200
5 of 25 sample ratesHigher to lower in this preview
Houston Methodist St. John Hospital, Houston Methodist Clear Lake Hospital
Methodist Hospital
$6,148.00Published rateSalvatore Sclafani
$1,171.83Published rateClemens Soeller
Franklin Medical Center Employee Benefit Plan Trust
$549.91Published rateGustavo Godoy
Lmg, LLC
$461.55Published rateJason Rudd
Paul Van Deventer M.D.
$352.64Published rate
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See a sample payer proposalCPT 46200 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46200 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 46200 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 |
|---|---|---|
| 46050-CPT | Moderate | I&D Abscess Perianal Superficial |
| 46070-CPT | Moderate | Inc Anal Septum Infant |
| 46080-CPT | Moderate | Sphincterotomy,Anal,Divis-Sphincter |
| 46200-CPT | Moderate | Surgery Anal Tissue Repair, Surgery To Repair A Fissure (Deep Crack) In The Tissues. The Procedure May Include Removing A Portion Of The Sphincter Muscle. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46200 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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