CPT 46706 Anal Fistula Repair Reimbursement | OpenPayer

Summary & Overview

CPT 46706: Anal Fistula Repair with Fibrin Glue

CPT code 46706 represents a minimally invasive surgical technique for anal fistula repair that uses fibrin glue to occlude the fistula tract. The procedure offers a sphincter-sparing option that can reduce wound healing time and preserve continence compared with more invasive fistulotomy approaches. Nationally, interest in fibrin glue procedures centers on clinical outcomes, utilization patterns, and payer coverage policies that affect patient access to this specialized treatment.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines typical sites of service, clinical context for use, and the types of benchmarks and policy issues readers can expect. That includes coverage criteria variance among major payers, utilization benchmarks, and coding guidance to support accurate billing.

Readers will learn the clinical indications and procedural intent behind CPT code 46706, how major payers approach coverage and prior authorization (where applicable), and what performance and utilization benchmarks are relevant for ambulatory surgery and outpatient settings. The report also highlights emerging policy considerations tied to minimally invasive anorectal procedures and practical documentation points for coding clarity. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare46706CPTanal fistulafibrin gluesurgical proceduresambulatory surgeryoutpatientfistula repair

Billing Code Overview

CPT code 46706 describes a procedure to repair an anal fistula by injecting fibrin glue into the fistula tract. The technique treats a small tunnel or tract that has an internal opening in the anal canal and an external opening in the skin near the anus.

Service type: Surgical/endoscopic fistula repair using biologic adhesive

Typical site of service: Ambulatory surgery center or hospital outpatient department, with possible performance in an office procedure setting depending on clinical complexity and facility capabilities.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents to an outpatient colorectal clinic with persistent drainage and intermittent perianal pain consistent with an anal fistula. Prior evaluation includes anorectal examination and confirmation of an external opening with an internal opening visualized on anoscopy and/or endoanal ultrasound. Conservative measures (sitz baths, antibiotics as indicated) have failed or are not appropriate. The colorectal surgeon schedules a minimally invasive office or ambulatory surgical center procedure to repair the fistula by applying fibrin glue (CPT 46706).

The typical workflow includes pre-procedure consent and verification of the fistula tract, local or regional anesthesia (or monitored anesthesia care depending on complexity and patient factors), probing and gentle curettage of the tract, and injection of fibrin glue to occlude the tract from the internal opening toward the external opening. Procedures are most often performed in an ambulatory surgery center or outpatient operating room; simpler applications may occur in an office procedure suite. Post-procedure instructions include wound care, stool softeners, activity restrictions, and follow-up to assess healing and detect recurrence.

Coding Specifications

Modifier	Description	When to Use
`11`	Special report (usual, customary)	Use when this is the provider's usual professional service designation; billing routines commonly include as primary.

CPT 46707: Anorectal Fistula Repair with Tissue Flap

CPT-46735-HIGH-IMPERFORATE-ANUS-REPAIR-TRANSABDOMINAL-SACROPERINEAL

CPT 46735: Repair of High Imperforate Anus Without Fistula

CPT-46748-CLOACAL-ANOMALY-REPAIR-ABDOMINAL-SACROPERINEAL

CPT 46748: Cloacal Anomaly Repair with Vaginal Lengthening

CPT-46710-ILEOANAL-POUCH-FISTULA-REPAIR-POUCH-ADVANCEMENT-PERINEAL

CPT 46710: Ileoanal Pouch Fistula or Sinus Repair by Pouch Advancement

CPT-46730-HIGH-IMPERFORATE-ANUS-REPAIR-PERINEAL-SACROPERINEAL

CPT 46730: Repair of High Imperforate Anus Without Fistula

CPT-46746-CLOACAL-ANOMALY-REPAIR-ABDOMINAL-SACROPERINEAL

CPT 46746: Repair of Cloacal Anomaly with Abdominal and Sacroperineal Approach

CPT-46751-PEDIATRIC-ANAL-SPHINCTER-RECONSTRUCTION

CPT 46751: Pediatric Anal Sphincter Reconstruction

CPT-46760-SPHINCTEROPLASTY-ANAL-SPHINCTER-RECONSTRUCTION

CPT 46760: Sphincteroplasty with Muscle Transplant

CPT-46750-ANAL-SPHINCTEROPLASTY-RECONSTRUCTION

CPT 46750: Anal Sphincteroplasty, Surgical Reconstruction

CPT-46712-ILEOANAL-POUCH-FISTULA-REPAIR-POUCH-ADVANCEMENT

CPT 46712: Ileoanal Pouch Fistula/Sinus Repair, Pouch Advancement

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Taxonomy Code	Specialty	Notes
`207K00000X`	Colon & Rectal Surgery	Colorectal surgeons commonly perform `CPT 46706` and manage complex fistula disease.
`207L00000X`	General Surgery	General surgeons with anorectal expertise may perform fibrin glue fistula repair.
`207Q00000X`	Surgical Oncology	Surgical oncologists with colorectal focus may manage fistulas in complex oncologic contexts.
`207RI0201X`	Family Medicine (procedural)	In limited settings, procedural family physicians with anorectal procedural training may perform office-based glue application.
`2080P0207X`	Gastroenterology	Interdisciplinary gastroenterologists may participate in diagnosis and endoscopic evaluation though they less commonly perform the glue application.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.3`	Fistula-in-ano	Primary diagnosis indicating an anal fistula appropriate for fibrin glue repair.
`K60.4`	Abscess of anal and rectal regions	Abscess may be associated with fistula formation; source control often precedes definitive repair.
`K60.0`	Anal fissure	Distinct anorectal condition; important to differentiate from fistula when planning treatment.
`K50.11`	Crohn disease of the small intestine with fistula	Crohn disease is a common etiologic factor for complex anal fistulas; impacts choice of repair technique.
`K51.21`	Ulcerative colitis with rectal bleeding	While less commonly causing fistulae, inflammatory bowel disease diagnoses are relevant for preoperative assessment.
`R19.4`	Change in bowel habit	Symptom code that may be present during evaluation; contributes to overall clinical assessment.
`L98.3`	Fistula of skin, non-traumatic	General skin fistula code that may be used when perianal skin fistula classification is applied.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46900`	Fistulectomy, simple (e.g., intersphincteric, ischiorectal, and subcutaneous)	Alternative surgical approach; may be performed when fibrin glue is unsuitable or if fistula tract requires excision rather than occlusion.
`46910`	Fistulectomy, complex (including repair of complex fistula-in-ano)	Performed for complex or branching tracts where glue alone would likely fail; may be done in staged care with `46706` considered for simpler tracts.
`46255`	Incision and drainage of ischiorectal abscess, simple or complicated	May precede fistula repair if abscess is present; source control is often performed prior to definitive fistula closure such as with fibrin glue.
`45378`	Diagnostic colonoscopy, flexible, proximal to splenic flexure	Performed adjunctively to evaluate for Crohn disease or other colonic pathology when fistula etiology is uncertain prior to definitive repair.
`76998`	Ultrasound, guidance for needle placement (unlisted) / Endoanal ultrasound (use actual ultrasound CPT if available)	Imaging guidance such as endoanal ultrasound aids in tract delineation prior to glue injection; reported when separate, billable ultrasound guidance service is provided.
`99024`	Postoperative follow-up visit, global period	Represents postoperative follow-up services related to the procedure during the global period; used for documenting routine follow-up care after `CPT 46706`.

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