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    OpenPayerBilling CodesIntroduction Procedures on the AnusCPT cpt-46505-anal-sphincter-chemodenervation
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    CPT 46505: Chemodenervation of Anal Sphincter

    Medicare pays $354 on average nationally for this procedure.

    CPT code 46505 describes a chemodenervation procedure in which a provider injects a pharmacologic agent into the anal sphincter to interrupt nerve signaling and relieve a sphincter muscle spasm; this is a therapeutic injection typically performed in an ambulatory surgical center or procedure room and is used for focal sphincter hypertonicity or anal fissure-related spasm.

    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 an adult presenting to an outpatient colorectal surgery or gastroenterology clinic with chronic internal anal sphincter hypertonicity or persistent anal fissure refractory to conservative therapy. The patient reports severe anal pain with bowel movements despite stool softeners, topical nitrates or calcium channel blockers, and Sitz baths. After clinical assessment and exclusion of infection, inflammatory bowel disease, or malignancy, the provider recommends chemodenervation of the internal anal sphincter to reduce resting tone and promote fissure healing.

    The clinical workflow: the patient is scheduled in an ambulatory procedure room or endoscopy suite. Pre-procedure evaluation includes consent, review of anticoagulation, and brief history and focused exam. The provider administers local anesthesia as needed, then injects botulinum toxin into one or more quadrants of the anal sphincter under direct visualization or palpation. The patient is monitored briefly for adverse effects and discharged with post-procedure instructions and follow-up to assess symptom improvement and wound healing. Typical site of service is an ambulatory surgical center or physician office procedure room.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    46600Examination of anus and rectum, anoscopy; diagnosticPerformed before or during evaluation to visualize fissure or sphincter pathology.
    45330Flexible endoscopy of the colon; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)May be performed in diagnostic workup if distal colon or inflammatory disease needs evaluation prior to intervention.
    99152Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes (Note: example of conscious sedation reporting; check payer guidance)Used when moderate sedation is provided during the procedure and must be reported per payer rules.
    99070Supplies and materials (except for drugs, devices, and biologicals) provided by the physician over and above those usually included with the procedureUsed to report additional disposable supplies or specialized injectables when payer allows.
    J0585Injection, onabotulinumtoxinA, 1 unitReported for billing the specific botulinum toxin units used for chemodenervation when applicable and supported by payer policy.

    Related Modifiers

    10 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…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    208000000X
    2086S0122X
    207L00000X
    224ZF0002X
    224P00000X
    163WM0705X
    204D00000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    B96.89Other specified bacterial agents as the cause of diseases classified elsewhere
    F45.41Pain disorder exclusively related to psychological factors
    G83.4Cauda equina syndrome
    G83.9Paralytic syndrome, unspecified
    K57.31Diverticulosis of large intestine without perforation or abscess with bleeding
    K57.51Diverticulosis of both small and large intestine without perforation or abscess with bleeding
    K58.0Irritable bowel syndrome with diarrhea
    K59.1Functional diarrhea
    K60.0Acute anal fissure
    K60.1Chronic anal fissure

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    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-46500-HEMORRHOID-SCLEROTHERAPY-INJECTION-SUBMUCOSA

    CPT 46500: Injection Sclerotherapy for Internal 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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