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    OpenPayerBilling CodesRepair Procedures on the AnusCPT cpt-46744-cloacal-anomaly-repair-sacroperineal-approach
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    CPT 46744: Repair of Cloacal Anomaly via Sacroperineal Approach

    Medicare pays $3324 on average nationally for this procedure.

    CPT code 46744 describes surgical repair of a cloacal anomaly involving reconstruction of a female anorectal and vaginal defect, with repair of any urethral wall injury, performed via a sacroperineal approach; service type: surgical repair/reconstruction, typical site of service: operating room (inpatient or outpatient surgical center).

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

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a newborn or infant female diagnosed with a cloacal malformation identified at birth or shortly after due to absent or abnormal anal opening, combined genitourinary and anorectal anomalies, or abnormal perineal anatomy. Presentation often includes meconium passage through a common urogenital channel, urinary tract dilation or infection, and inability to pass stool normally. Initial evaluation includes physical exam, abdominal and pelvic ultrasound, pelvic MRI, and possibly contrast studies to delineate the length of the common channel and associated renal or spinal anomalies. The surgical team—pediatric colorectal surgeon and pediatric urologist—plans definitive reconstruction after initial stabilization, bowel management, and infection control.

    The procedure described by 46744 is a sacroperineal approach to repair the cloacal anomaly, reconstruct the anorectal canal and vaginal anatomy, and repair any urethral wall injury. Typical workflow includes preoperative imaging and bowel preparation, multidisciplinary operative planning, anesthesia for an infant or child, intraoperative cystoscopy or vaginoscopy as needed, sacroperineal dissection and reconstruction, and postoperative monitoring in a pediatric surgical unit with attention to urine output, wound healing, and bowel function. Follow-up includes urology and colorectal assessments, imaging as indicated, and long-term bowel and urinary continence management.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    54160Repair of urethral stricture; simple, with dilatation and direct vision internal urethrotomy as indicatedMay be performed if urethral reconstruction or stricturoplasty is required during genitourinary repair associated with cloacal reconstruction.

    | 56830 | Repair of obstetric or nonobstetric vulvar/vaginal laceration, complex, deep or extensive (including vaginal wall and sphincter repair) | May be used for complex vaginal wall repairs or reconstruction when separate coding for extensive vaginal repair is required alongside cloacal reconstruction.

    | 45330 | Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing | Diagnostic endoscopic evaluation of distal rectum/anorectal anatomy intraoperatively or preoperatively; adjunct diagnostic code when performed.

    | 51702 | Cystourethroscopy, with or without injection, with diagnostic evaluation of bladder and urethra, with or without collection of specimens | Commonly performed intraoperatively to evaluate the urethra and bladder anatomy prior to or during cloacal repair.

    | 49440 | Repair of enterocutaneous fistula; simple | May be performed if enteric fistulae are present or created during complex pelvic reconstruction and require separate repair.

    | 57460 | Colposcopy of the cervix, with biopsy | May be used in older patients when vaginal/cervical anatomy requires direct visualization and biopsy during staged reconstruction.

    Related Modifiers

    13 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…
    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…
    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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    2080P0208XPediatric Infectious Diseases PhysicianA pediatrician trained to care for children in the diagnosis, treatment and prevention of infectious diseases. This specialist can apply specific know…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208M00000XHospitalist PhysicianHospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient ca…
    207ZH0000XHematology (Pathology) PhysicianA hematopathologist is expert in diseases that affect blood cells, blood clotting mechanisms, bone marrow and lymph nodes. This physician has the know…
    156FC0800XContact Lens Technician/TechnologistAn optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact …
    261QA0600XAdult Day Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    261QR0200XRadiology Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    N34.2Other urethritis
    N36.0Urethral fistula
    N36.1Urethral diverticulum
    N36.9Urethral disorder, unspecified
    N39.3Stress incontinence (female) (male)
    Q42.8Congenital absence, atresia and stenosis of other parts of large intestine
    Q43.3Congenital malformations of intestinal fixation
    Q44.2Atresia of bile ducts
    Q45.3Other congenital malformations of pancreas and pancreatic duct
    Q53.9Undescended testicle, unspecified

    Showing 1–10 of 22

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    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
    Inpatient Surgical Site of ServiceProvidence Health Plan2026-07-01
    Removal of Implantable DevicesBlue Cross Blue Shield - Rhode Island2026-07-01

    Related Codes

    CPT-46700-ANOPLASTY-ANAL-STRICTURE-REPAIR

    CPT 46700: Anoplasty for Anal Stricture, Adult

    CPT-46705-ANOPLASTY-INFANT-ANAL-STRICTURE

    CPT 46705: Anoplasty for Infant Anal Stricture

    CPT-46706-ANAL-FISTULA-REPAIR-FIBRIN-GLUE

    CPT 46706: Fibrin Glue Repair of Anal Fistula

    CPT-46707-ANORECTAL-FISTULA-REPAIR-TISSUE-FLAP

    CPT 46707: Anorectal Fistula Repair with Tissue Closure

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

    CPT 46710: Ileoanal Pouch Advancement and Fistula/Sinus Repair

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

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

    CPT-46715-REPAIR-LOW-IMPERFORATE-ANUS-ANORECTAL-RECONSTRUCTION

    CPT 46715: Repair of Low Imperforate or Malformed Anus

    CPT-46716-LOW-IMPERFORATE-ANUS-REPAIR-ANORECTAL-MALFORMATION

    CPT 46716: Repair of Low Imperforate or Malformed Anus

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

    CPT 46730: Repair of High Imperforate Anus, No Fistula

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

    CPT 46735: Repair of High Imperforate Anus, No Fistula

    Showing 1–10 of 20

    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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