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    OpenPayerBilling CodesIncision Procedures on the AnusCPT cpt-46045-rectal-perirectal-abscess-drainage-transanal
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    CPT 46045: Transanal Incision and Drainage of Rectal/Perirectal Abscess

    Medicare pays $457 on average nationally for this procedure.

    CPT code 46045 describes an incision and drainage procedure for a rectal or perirectal abscess performed through the anal canal under anesthesia; this is a surgical abscess drainage service typically provided in an operating room or procedure suite with the patient under anesthesia to enable transanal access and layered drainage of purulent material.

    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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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a 35–55-year-old adult presenting to the emergency department or ambulatory surgical center with perianal pain, swelling, erythema, and fever consistent with an anorectal abscess. Clinical evaluation includes history, focused anorectal exam, and, when indicated, bedside ultrasound or pelvic imaging to define abscess extent. The patient is taken to a minor procedure room or operating room, placed under appropriate anesthesia (local with sedation, spinal, or general), and positioned in lithotomy. The treating surgeon performs an anal canal approach incision and drainage through the sphincter complex to establish drainage of multiloculated pus from perirectal spaces, irrigates the cavity, removes loculations as needed, and places packing or a drain if indicated. Post-procedure care includes analgesia, wound care instructions, possible antibiotics for systemic signs or immunocompromise, and scheduling of follow-up for wound inspection and evaluation for fistula formation.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    46045Incision and drainage of perirectal abscess; transanal approach, incision through sphincteric complex with drainage at different layers under anesthesiaPrimary procedure: direct description of the operative drainage via anal canal (the billed code).
    46040Incision and drainage of perirectal abscess; simple perianal or perirectal approach, superficial abscess without transanal sphincterotomyAlternative/related: used for more superficial perianal abscesses that do not require transanal sphincterotomy.
    46970Fistulotomy or fistulectomy, superficialCommon subsequent or concurrent procedure when an associated anal fistula is identified and treated during drainage or at follow-up.
    99152Anesthesia for procedures on the perineum and lower abdomen; for procedures of 30–90 minutes, patient <1 year or older with complicated anesthesia (example anesthesia codes vary by payer)Ancillary service: anesthesia services commonly reported when patient receives monitored anesthesia care or general anesthesia for 46045.
    12031Repair, intermediate, simple (e.g., wound closure)Potential adjunct: used for repair of associated perianal lacerations or incidental external skin wounds if closed during the same encounter.

    Related Modifiers

    12 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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    207L00000X
    207RA0000X
    207T00000X
    261QM2800X
    2278P1006X
    2084N0402X
    207ZI0100X

    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-46020-ANAL-SETON-PLACEMENT

    CPT 46020: Placement of Anal Seton

    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-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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