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See a sample rate comparisonCPT 46275 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 SG - Scene to Hospital ESRD facility GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46275 |
| Medicaid Fee Schedule | View Medicaid rates for 46275 |
National average reimbursement for CPT 46275 by major payers:
$653.57
$692.53
$771.71
$678.03
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CPT 46275
5 of 25 sample ratesHigher to lower in this preview
Slidell Memorial Hospital, Md Imaging Slidell
Slidell Memorial Hospital
$5,633.25Published rateAscension Seton, Ascension Seton Northwest
Ascension Seton
$2,371.00Published rateSurgery Centers Of Des Moines Ltd
$1,370.00Published ratePinehurst Medical Clinic Inc, Pinehurst Medical Clinic Endoscopy Center
Pinehurst Medical Clinic, Inc.
$922.00Published ratePhoenix Vamc
$492.55Published rate
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See a sample payer proposalCPT 46275 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46275 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 46275 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 |
|---|---|---|
| 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. |
| 46275-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. |
| 46280-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. |
| 46288-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 46275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46275 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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