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See a sample rate comparisonCPT 46285 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 58 - Staged or related procedure during postoperative period GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46285 |
| Medicaid Fee Schedule | View Medicaid rates for 46285 |
National average reimbursement for CPT 46285 by major payers:
$628.34
$678.46
$746.73
$672.15
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CPT 46285
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Surgery Center Kirby, LLC, Memorial Hermann Surgery Center Kirby Glen
$5,729.00Published rateBangor Eye Surgery, PA
Bangor Eye Surgery PA
$1,750.00Published rateFresenius Vascular Care Dayton Asc LLC
$1,300.00Published rateSurgery Center Of Anaheim Hills, LLC
Surgery Center Of Anaheim Hills LLC
$1,155.00Published rateNona Patton
Deaconess Hospital Inc
$435.45Published rate
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See a sample payer proposalCPT 46285 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46285 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 46285 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. |
| 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. |
| 46285-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 46285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46285 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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