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See a sample rate comparisonCPT 46270 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 To Close Anal Fistula, Surgery To Close Off An Anal Fistula. This Is A Small Abnormal Tunnel That Starts In The Anal Canal Or Passageway And Ends At The Surface Of Skin Or Elsewhere In The Body.
| 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 GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46270 |
| Medicaid Fee Schedule | View Medicaid rates for 46270 |
National average reimbursement for CPT 46270 by major payers:
$602.12
$654.53
$737.52
$638.09
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CPT 46270
5 of 25 sample ratesHigher to lower in this preview
Grass Valley Outpatient Surgery Center Lp, Grass Valley Surgery Center
$4,304.00Published rateBay Area Surgical Group, Inc.
$2,538.00Published rateBrunswick Surgery Center LLC
$1,588.00Published rateHenderson Surgery Center
Henderson Surgery Center LLC
$1,103.00Published rateCentral Arizona Gi & Liver Institute LLC
$550.00Published rate
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See a sample payer proposalCPT 46270 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46270 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 46270 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 |
|---|---|---|
| 46045-CPT | Moderate | Incision Of Rectal Abscess, Incision And Drainage Of Intramural Intramuscular Or Submucosal Abscess Transanal Under Anesthesia |
| 46060-CPT | Moderate | Incision Of Rectal Abscess, Incision And Drainage Of Ischiorectal Or Intramural Abscess With Fistulectomy Or Fistulotomy Submuscular With Or Without Placement Of Seton |
| 46260-CPT | Moderate | Hemorrhoid Surgery, Surgery To Remove One Or More Internal Or External Hemorrhoids. The Procedure May Include Repairing Nearby Tissue. |
| 46270-CPT | Moderate | Surgery To Close Anal Fistula, Surgery To Close Off An Anal Fistula. This Is A Small Abnormal Tunnel That Starts In The Anal Canal Or Passageway And Ends At The Surface Of Skin Or Elsewhere In The Body. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46270 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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