CPT code 46220: Anal tag excision, single external tag2026 Medicare rate & RVUs in California
Reports excision of one external anal skin tag or papilla when the treated tissue is a tag rather than hemorrhoidal disease.
Medicare pays $292.44–$371.17 for 46220 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 46220 covers
A clinician removes one external anal skin tag or hypertrophied anal papilla, typically to address irritation, hygiene difficulty, or discomfort. Colorectal and general surgeons commonly perform the procedure in an office or outpatient setting, with the site examined and the lesion excised. The operative note should identify the external lesion and document that one tag or papilla was removed, rather than describing treatment of hemorrhoids or an anal fissure.
Report this code for a single external tag; use the multiple-tag code when more than one is excised. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 46220 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$292.44 to $371.17
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $293.26 | $122.30 |
| Chico, CA | $292.44 | $121.49 |
| El Centro, CA | $292.49 | $121.54 |
| Fresno, CA | $292.44 | $121.49 |
| Hanford, CA | $292.44 | $121.49 |
| Los Angeles, CA | $313.51 | $128.98 |
| Madera, CA | $292.44 | $121.49 |
| Marin County, CA | $362.81 | $142.87 |
| Merced, CA | $292.44 | $121.49 |
| Modesto, CA | $292.44 | $121.49 |
| Napa, CA | $341.97 | $136.38 |
| Oxnard, CA | $312.22 | $127.85 |
| Redding, CA | $292.44 | $121.49 |
| Rest of California | $292.44 | $121.49 |
| Riverside, CA | $295.57 | $124.61 |
| Sacramento, CA | $307.74 | $126.33 |
| Salinas, CA | $306.62 | $125.84 |
| San Benito County, CA | $371.17 | $146.24 |
| San Diego, CA | $314.53 | $127.97 |
| San Francisco, CA | $362.48 | $142.54 |
| San Luis Obispo, CA | $301.62 | $123.96 |
| Santa Clara County, CA | $369.82 | $144.90 |
| Santa Cruz, CA | $318.05 | $128.53 |
| Santa Maria, CA | $307.96 | $126.09 |
| Santa Rosa, CA | $321.30 | $129.75 |
| Stockton, CA | $292.44 | $121.49 |
| Vallejo, CA | $341.49 | $135.91 |
| Visalia, CA | $292.44 | $121.49 |
| Yuba City, CA | $292.44 | $121.49 |
How the 46220 rate is calculated
Each of 46220’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46220
RVUs × geographic indexes × conversion factor
Work1.57
1.57 RVUs× 1.000 GPCI
Practice expense6.39
6.39 RVUs× 1.000 GPCI
Malpractice0.29
0.29 RVUs× 1.000 GPCI
Adjusted RVUs
8.2500
Conversion factor
$33.4009
Medicare rate
$275.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46220
46220 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46220
Anal tag excision, single external tag
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46220
Anal tag excision, single external tag
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46220 without 51 · national office
$275.56
Anal tag excision, single external tag
46220-51 · Second procedure: 50%
$137.78
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
46220 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46230Anal tag excisionMultiple tags
- 46220 is for one external tag or papilla; 46230 is for multiple external tags.
- 46221Hemorrhoid ligationRubber-band technique
- 46221 treats hemorrhoids by ligation. Choose 46220 only when the excised lesion is an external tag or papilla.
- 46250HemorrhoidectomyExternal, two or more groups
- 46250 is hemorrhoidectomy for multiple external hemorrhoid groups; 46220 is for a single external tag or papilla.
46220 billing questions
When should this code be chosen over 46230?
Use this code when one external anal tag or papilla is excised. Use 46230 when multiple external tags are removed.
Can this code be reported for hemorrhoid removal?
No. It describes excision of an external tag or papilla, not hemorrhoidal tissue. Select the hemorrhoid procedure that matches the documented disease and operative treatment.
Are related postoperative visits separately reported?
Visits related to the procedure during its 10-day global period are included.
Should modifier 50 be appended for tags on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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