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CPT code 46220: Anal tag excision, single external tag2026 Medicare rate & RVUs in North Carolina

Reports excision of one external anal skin tag or papilla when the treated tissue is a tag rather than hemorrhoidal disease.

CMS RVU26DEffective Oct 1, 2026One payment locality991 Medicare services in 2024

In North Carolina, Medicare pays $257.76 for 46220 in the office and $112.23 when it’s performed in a hospital or facility.

$257.76Office (non-facility)
$112.23Hospital or facility
−6.5%vs the national office rate ($275.56)

Check a contract rate as a % of Medicare · 46220 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 46220 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 46220 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Carolina compares for 46220

Across 109 of 109 payment localities, the office rate for 46220 runs from $240.77 in Arkansas to $371.17 in San Benito County, CA. North Carolina pays $257.76. The RVUs are the same everywhere; the geographic indexes change the dollars.

46220 in North Carolina vs other payment areas
  1. North Carolina · this page$257.76
  2. Los Angeles, CA · California$313.51+$55.75
  3. Washington, DC area · District of Columbia$317.47+$59.71
  4. Miami, FL · Florida$299.12+$41.36
  5. Chicago, IL · Illinois$289.54+$31.78
  6. Manhattan, NY · New York$319.17+$61.41
  7. Alaska · Alaska$311.30+$53.54

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

46220 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$244.67$108.19
ArkansasArkansas$240.77$106.78
ArizonaArizona$267.55$116.40
Bakersfield, CACalifornia$293.26$122.30
Chico, CACalifornia$292.44$121.49
El Centro, CACalifornia$292.49$121.54
Fresno, CACalifornia$292.44$121.49
Hanford, CACalifornia$292.44$121.49

46220 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$240.77

$331.81

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
46220 office rate range by state
State / territoryOffice rate rangeLocalities
AK$311.301
AL$244.671
AR$240.771
AZ$267.551
CA$292.44–$371.1729
CO$287.731
CT$295.071
DC$317.471
DE$272.281
FL$271.04–$299.123
GA$254.37–$281.082
GU$300.721
HI$300.721
IA$251.571
ID$253.381
IL$262.44–$289.544
IN$255.001
KS$250.261
KY$251.041
LA$250.61–$264.282
MA$285.74–$318.052
MD$277.85–$317.473
ME$254.82–$270.062
MI$258.24–$274.732
MN$274.931
MO$245.85–$265.333
MS$243.361
MT$275.541
NC$257.761
ND$269.801
NE$253.101
NH$283.101
NJ$298.23–$313.672
NM$259.791
NV$274.151
NY$262.01–$327.555
OH$257.071
OK$250.561
OR$271.83–$297.612
PA$257.52–$287.122
PR$277.761
RI$282.551
SC$257.881
SD$269.131
TN$251.651
TX$255.66–$286.948
UT$261.761
VA$269.08–$317.472
VI$277.761
VT$268.641
WA$285.24–$324.862
WI$259.891
WV$251.771
WY$273.041

See 46220 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,580

Code
46220
Physician work
1.57
Practice expense
6.39
Malpractice
0.29

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 46220 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.57× 1.0001.5700
Practice expense6.39× 0.9335.9619
Malpractice0.29× 0.6390.1853
Total RVUs7.7172
Conversion factor× 33.4009

Office rate, North Carolina$257.76

Office: (1.57 × 1 + 6.39 × 0.933 + 0.29 × 0.639) × $33.4009 = $257.76

Facility: (1.57 × 1 + 1.72 × 0.933 + 0.29 × 0.639) × $33.4009 = $112.23

Open 46220 in the RVU calculator

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

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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%).

When to use modifier 51

Codes related to 46220

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 46220
CodeHow it relatesOffice range, North Carolina
Same family
46230Anal tag excision, multiple tagsUsed for excision of multiple external anal tags rather than a single tag.$320.41
Used instead
46250Hemorrhoidectomy, external, two or more groupsUse for excision of multiple external hemorrhoid groups, not isolated skin tags.$501.81
46255Hemorrhoidectomy, one internal and external groupUse when the operative target is one internal or external hemorrhoid group.$543.82

How 46220 has changed in North Carolina

46220 · Office / nonfacility

$257.76

Effective 2026-10-01

The base rate is $32.61 higher than on 2025-10-01, moving from $225.15 to $257.76 (14.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $225.15changed to$257.76

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.61 changed to 1.57
    • Practice expense RVU 5.57 changed to 6.39
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $234.39changed to$225.15

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.65 changed to 5.57
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $230.57changed to$234.39

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $240.28changed to$230.57

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.68 changed to 5.65
    • Malpractice RVU 0.29 changed to 0.30
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $247.63changed to$240.28

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.72 changed to 5.68
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $241.95changed to$247.63

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.49 changed to 5.72
    • Malpractice RVU 0.28 changed to 0.29

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $221.82changed to$241.95

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.65 changed to 5.49
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $210.06changed to$221.82

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.30 changed to 4.65
    • Malpractice RVU 0.31 changed to 0.28
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $200.53changed to$210.06

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.03 changed to 4.30
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $198.31changed to$200.53

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.97 changed to 4.03
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $198.03changed to$198.31

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.96 changed to 3.97
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $199.47changed to$198.03

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.99 changed to 3.96
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $198.48changed to$199.47

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $196.73changed to$198.48

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.95 changed to 3.99
    • Malpractice RVU 0.29 changed to 0.30
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $201.59changed to$196.73

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.43 changed to 3.95
    • Malpractice RVU 0.30 changed to 0.29
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $201.59

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$257.76$112.23RVU26D
2026-07-01$257.76$112.23RVU26C
2026-04-01$257.76$112.23RVU26B
2026-01-01$257.76$112.23RVU26A
2025-10-01$225.15$112.23RVU25D
2025-07-01$225.15$112.23RVU25C
2025-04-01$225.15$112.23RVU25B
2025-01-01$225.15$112.23RVU25A
2024-10-01$234.39$114.79RVU24D
2024-07-01$234.39$114.79RVU24C
2024-04-01$234.39$114.79RVU24B
2024-03-09$234.39$114.79RVU24AR
2024-01-01$230.57$112.92RVU24A
2023-10-01$240.28$116.51RVU23D
2023-07-01$240.28$116.51RVU23C
2023-04-01$240.28$116.51RVU23B
2023-01-01$240.28$116.51RVU23A
2022-10-01$247.63$118.21RVU22D
2022-07-01$247.63$118.21RVU22C
2022-04-01$247.63$118.21RVU22B
2022-01-01$247.63$118.21RVU22A
2021-10-01$241.95$117.61RVU21D
2021-07-01$241.95$117.61RVU21C
2021-04-01$241.95$117.61RVU21B
2021-01-01$241.95$117.61RVU21A
2020-10-01$221.82$117.44RVU20D
2020-07-01$221.82$117.44RVU20C
2020-04-01$221.82$117.44RVU20B
2020-01-01$221.82$117.44RVU20A
2019-10-01$210.06$116.79RVU19D
2019-07-01$210.06$116.79RVU19C
2019-04-01$210.06$116.79RVU19B
2019-01-01$210.06$116.79RVU19A
2018-10-01$200.53$116.07RVU18D
2018-07-01$200.53$116.07RVU18C
2018-04-01$200.53$116.07RVU18B
2018-01-01$200.53$116.07RVU18AR1
2017-10-01$198.31$116.11RVU17D
2017-07-01$198.31$116.11RVU17C
2017-04-01$198.31$116.11RVU17B
2017-01-01$198.31$116.11RVU17A
2016-10-01$198.03$116.12RVU16D
2016-07-01$198.03$116.12RVU16C
2016-04-01$198.03$116.12RVU16B
2016-01-01$198.03$116.12RVU16A
2015-10-01$199.47$116.93RVU15D
2015-07-01$199.47$116.93RVU15C
2015-04-01$198.48$116.35RVU15B
2015-01-01$198.48$116.35RVU15A
2014-10-01$196.73$115.53RVU14D
2014-07-01$196.73$115.53RVU14C
2014-04-01$196.73$115.53RVU14B
2014-01-01$196.73$115.53RVU14A
2013-10-01$201.59$114.54RVU13D
2013-07-01$201.59$114.54RVU13C
2013-04-01$201.59$114.54RVU13B
2013-01-01$201.59$114.54RVU13AR

Price 46220 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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
RVUs for 46220PPRRVU2026_Oct_nonQPP.csv, line 5,580 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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