Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 46280 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 GC - Service performed by resident under supervision AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46280 |
| Medicaid Fee Schedule | View Medicaid rates for 46280 |
National average reimbursement for CPT 46280 by major payers:
$582.16
$615.88
$671.25
$770.35
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 46280.
CPT 46280
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$7,810.00Published rateThe Outpatient Center, LLC, The Outpatient Center Of Boynton Beach, Ltd.
The Outpatient Center Of Boynton Beach, Ltd.
$2,206.00Published rateEndoscopy Center Of Santa Maria Inc, The Endoscopy Center Of Santa Maria, Inc.
Endoscopy Center Of Santa Maria, Inc.
$1,270.00Published rateMountain Home Surgery Center, Inc.
$950.00Published rateCentral Ohio Urology Surgery Center, LLC
Central Ohio Urology Surgery Center LLC
$771.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 46280 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46280 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 46280 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 |
|---|---|---|
| 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. |
| 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 |
| 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. |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46280 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 46280) and we'll show you how you compare in 15 minutes or less.