Summary & Overview
CPT 46730: Repair of High Imperforate Anus Without Fistula
CPT code 46730 denotes surgical repair of a high imperforate anus without fistula, performed by perineal or sacroperineal approach. This congenital anorectal reconstruction is typically performed in an operating room setting, most often as an inpatient procedure for neonates or infants requiring definitive correction. Nationally, the code matters because it captures a specialized pediatric surgical service with implications for hospital surgical capacity, perioperative care pathways, and bundled payment or case-rate arrangements for complex congenital repairs.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, guidance on expected site-of-service patterns, and where to look for payer-specific coverage and authorization policies. The publication also summarizes common billing considerations, such as the surgical nature of the service and typical hospitalization, and outlines topics relevant to reimbursement benchmarking and policy updates affecting specialized pediatric surgical care.
This brief provides national-level context for clinicians, coding professionals, and revenue leaders seeking a concise reference to CPT code 46730, what it represents clinically, and the payer landscape relevant to this type of anorectal malformation repair.
Billing Code Overview
CPT code 46730 describes surgical repair of a high imperforate anus without fistula, performed via a perineal or sacroperineal approach. The procedure addresses a congenital malformation in which the rectal opening is absent and reconstruction of the distal rectum and perineal anatomy is required.
Service type: Surgical repair for congenital anorectal malformation
Typical site of service: Inpatient hospital operating room
Clinical & Coding Specifications
Clinical Context
A full-term neonate is born with an imperforate anus identified on newborn exam. The infant has a high-type imperforate anus without a perineal fistula on inspection and radiographic evaluation (cross-table lateral or invertogram) demonstrating the rectal pouch above the levator ani complex. The typical workflow includes initial stabilization in the neonatal unit, bowel decompression if needed, and consultation with pediatric surgery. Definitive repair is scheduled: the surgeon performs a posterior sagittal or sacroperineal approach to mobilize the rectum and create a neo-anus within the sphincter complex, consistent with the description of 46730. Preoperative evaluation includes anesthesia assessment, imaging to characterize the level of the malformation, and counseling with pediatric surgery and nursing. Postoperative care involves pain control, monitoring for complications (wound infection, stricture, fistula), stool regimen, and planned outpatient follow-up for anal dilations and functional assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use when no specific modifier applies to the service. |
11 |