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    v1.0.30
    OpenPayerBilling CodesIncision Procedures on the AnusCPT cpt-46020-anal-seton-placement
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    CPT 46020: Placement of Anal Seton

    Medicare pays $113 on average nationally for this procedure.

    CPT code 46020 describes the placement of an anal seton, a minor surgical procedure to place a draining or tension-maintaining loop through an anal fistula; service type: surgical procedure for anorectal fistula management; typical site of service: outpatient surgical suite, ambulatory surgery center, or hospital operating room depending on clinical complexity and anesthesia needs.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting to a colorectal clinic or ambulatory surgical center with a chronically draining perianal fistula or recurrent anorectal sepsis. After evaluation with history, physical exam, and often anoscopy or flexible sigmoidoscopy, a colorectal surgeon or general surgeon determines that placement of an anal seton is indicated to maintain drainage, prevent abscess recurrence, and allow fistula tract maturation prior to definitive repair. The procedure is usually performed under local anesthesia with sedation or under general anesthesia in the operating room depending on complexity and patient tolerance. The workflow includes preoperative localization of the fistula tract, probing of the tract, passage of a rubber or vessel-loop seton through the internal and external openings, securing the seton with a tie or knot, documentation of tract orientation and seton type, and postprocedure instructions for wound care and follow-up. Typical sites of service are outpatient surgery centers, hospital outpatient departments, or inpatient operating rooms for complex cases. Common clinical indications include transsphincteric or complex perianal fistula, Crohn disease–related fistulas, and recurrent perianal abscess with persistent fistulous tract.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    45378Diagnostic anoscopy, rigid or flexible, with or without collection of specimenOften performed preoperatively to localize the fistula/internal opening before seton placement.
    49020Drainage of perirectal abscess, transrectal; simplePerformed when an abscess is present prior to or at the time of seton placement to control infection.
    46010Fistulectomy, anorectal, simple; without repairMay be performed during the same operative episode when definitive excision of a simple fistula is indicated instead of or after seton placement.
    46255Fistulotomy, including marsupialization when performed, any locationUsed when definitive opening of the fistula tract is performed as an alternative to seton placement for low/simple fistulas.
    49650Ligation, fistula-in-ano, seton, or other repair of complex fistulaRelated complex fistula repairs that may follow chronic seton drainage prior to definitive closure.

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    207R00000X
    207Q00000X
    2080P0207X
    171400000X
    2086S0105X
    207ZN0500X
    207LP4000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    A07.2Cryptosporidiosis
    A64Unspecified sexually transmitted disease
    K57.32Diverticulitis of large intestine without perforation or abscess without bleeding
    K57.33Diverticulitis of large intestine without perforation or abscess with bleeding
    K57.92Diverticulitis of intestine, part unspecified, without perforation or abscess without bleeding
    K60.0Acute anal fissure
    K60.1Chronic anal fissure
    K60.2Anal fissure, unspecified
    K61.0Anal abscess
    K61.1Rectal abscess

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-46030-ANAL-SETON-REMOVAL-ANAL-FISTULA

    CPT 46030: Removal of Anal Seton or Marker

    CPT-46040-INCISION-DRAINAGE-ANORECTAL-ISCHIORECTAL-ABSCESS

    CPT 46040: Incision and Drainage of Anal/Ischiorectal Abscess

    CPT-46045-RECTAL-PERIRECTAL-ABSCESS-DRAINAGE-TRANSANAL

    CPT 46045: Transanal Incision and Drainage of Rectal/Perirectal Abscess

    CPT-46050-PERIANAL-SUPERFICIAL-ABSCESS-INCISION-DRAINAGE

    CPT 46050: Incision and Drainage of Superficial Perianal Abscess

    CPT-46060-PERIRECTAL-ABSCESS-INCISION-DRAINAGE-FISTULA-MANAGEMENT

    CPT 46060: Incision and Drainage of Abscess with Fistula Treatment

    CPT-46070-ANAL-MEMBRANE-INCISION-INFANT

    CPT 46070: Incision of Congenital Anal Membrane in Infant

    CPT-46080-ANAL-SPHINCTEROTOMY-RELEASE-OF-ANAL-CONTRACTURE

    CPT 46080: Anal Sphincterotomy to Release Anal Contracture

    CPT-46083-EXTERNAL-HEMORRHOID-THROMBECTOMY-INCISION-DRAINAGE

    CPT 46083: Incision and Thrombectomy of External Hemorrhoid

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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