CPT code 46220: Anal tag excision, single external tag2026 Medicare rate & RVUs in South Dakota
Reports excision of one external anal skin tag or papilla when the treated tissue is a tag rather than hemorrhoidal disease.
In South Dakota, Medicare pays $269.13 for 46220 in the office and $113.14 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How South Dakota 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. South Dakota pays $269.13. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$269.13
- Los Angeles, CA · California$313.51+$44.38
- Washington, DC area · District of Columbia$317.47+$48.34
- Miami, FL · Florida$299.12+$29.99
- Chicago, IL · Illinois$289.54+$20.41
- Manhattan, NY · New York$319.17+$50.04
- Alaska · Alaska$311.30+$42.17
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $292.44 | $121.49 |
| Merced, CACalifornia | $292.44 | $121.49 |
| Modesto, CACalifornia | $292.44 | $121.49 |
| Napa, CACalifornia | $341.97 | $136.38 |
| Oxnard, CACalifornia | $312.22 | $127.85 |
| Redding, CACalifornia | $292.44 | $121.49 |
| Rest of CaliforniaCalifornia | $292.44 | $121.49 |
| Riverside, CACalifornia | $295.57 | $124.61 |
| Sacramento, CACalifornia | $307.74 | $126.33 |
| Salinas, CACalifornia | $306.62 | $125.84 |
| San Diego, CACalifornia | $314.53 | $127.97 |
| Marin County, CACalifornia | $362.81 | $142.87 |
| San Francisco, CACalifornia | $362.48 | $142.54 |
| San Benito County, CACalifornia | $371.17 | $146.24 |
| Santa Clara County, CACalifornia | $369.82 | $144.90 |
| San Luis Obispo, CACalifornia | $301.62 | $123.96 |
| Santa Cruz, CACalifornia | $318.05 | $128.53 |
| Santa Maria, CACalifornia | $307.96 | $126.09 |
| Santa Rosa, CACalifornia | $321.30 | $129.75 |
| Stockton, CACalifornia | $292.44 | $121.49 |
| Vallejo, CACalifornia | $341.49 | $135.91 |
| Visalia, CACalifornia | $292.44 | $121.49 |
| Yuba City, CACalifornia | $292.44 | $121.49 |
| ColoradoColorado | $287.73 | $121.76 |
| ConnecticutConnecticut | $295.07 | $127.08 |
| DelawareDelaware | $272.28 | $118.17 |
| Fort Lauderdale, FLFlorida | $286.16 | $128.15 |
| Rest of FloridaFlorida | $271.04 | $121.92 |
| Atlanta, GAGeorgia | $281.08 | $122.60 |
| Rest of GeorgiaGeorgia | $254.37 | $115.23 |
| Hawaii, Guam, HIHawaii | $300.72 | $123.37 |
| IowaIowa | $251.57 | $108.85 |
| IdahoIdaho | $253.38 | $109.87 |
| East St. Louis, ILIllinois | $268.30 | $124.80 |
| Rest of IllinoisIllinois | $262.44 | $120.03 |
| Suburban Chicago, ILIllinois | $289.16 | $128.97 |
| IndianaIndiana | $255.00 | $110.40 |
| KansasKansas | $250.26 | $109.26 |
| KentuckyKentucky | $251.04 | $112.37 |
| New Orleans, LALouisiana | $264.28 | $117.50 |
| Rest of LouisianaLouisiana | $250.61 | $112.56 |
| Metropolitan Boston, MAMassachusetts | $318.05 | $131.80 |
| Rest of MassachusettsMassachusetts | $285.74 | $121.49 |
| Baltimore area, MDMaryland | $294.27 | $126.90 |
| Rest of MarylandMaryland | $277.85 | $119.99 |
| Rest of MaineMaine | $254.82 | $111.32 |
| Southern Maine, MEMaine | $270.06 | $115.48 |
| Detroit, MIMichigan | $274.73 | $124.21 |
| Rest of MichiganMichigan | $258.24 | $115.83 |
| MinnesotaMinnesota | $274.93 | $114.42 |
| Metropolitan Kansas City, MOMissouri | $262.32 | $115.85 |
| Metropolitan St. Louis, MOMissouri | $265.33 | $116.84 |
| Rest of MissouriMissouri | $245.85 | $111.40 |
| MississippiMississippi | $243.36 | $109.06 |
| MontanaMontana | $275.54 | $119.56 |
| North CarolinaNorth Carolina | $257.76 | $112.23 |
| North DakotaNorth Dakota | $269.80 | $113.82 |
| NebraskaNebraska | $253.10 | $109.13 |
| New HampshireNew Hampshire | $283.10 | $120.72 |
| Northern New JerseyNew Jersey | $313.67 | $132.73 |
| Rest of New JerseyNew Jersey | $298.23 | $127.90 |
| New MexicoNew Mexico | $259.79 | $116.75 |
| NevadaNevada | $274.15 | $118.02 |
| NYC suburbs and Long Island, NYNew York | $327.55 | $142.09 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $300.23 | $129.43 |
| Queens, NYNew York | $322.04 | $137.67 |
| Rest of New YorkNew York | $262.01 | $113.83 |
| OhioOhio | $257.07 | $114.65 |
| OklahomaOklahoma | $250.56 | $111.27 |
| Portland, OROregon | $297.61 | $124.31 |
| Rest of OregonOregon | $271.83 | $116.47 |
| Metropolitan Philadelphia, PAPennsylvania | $287.12 | $124.74 |
| Rest of PennsylvaniaPennsylvania | $257.52 | $114.33 |
| Puerto RicoPuerto Rico | $277.76 | $120.06 |
| Rhode IslandRhode Island | $282.55 | $121.42 |
| South CarolinaSouth Carolina | $257.88 | $113.76 |
| TennesseeTennessee | $251.65 | $109.86 |
| Austin, TXTexas | $286.94 | $121.91 |
| Beaumont, TXTexas | $255.66 | $113.72 |
| Brazoria, TXTexas | $271.93 | $117.35 |
| Dallas, TXTexas | $273.80 | $118.44 |
| Fort Worth, TXTexas | $271.79 | $117.99 |
| Galveston, TXTexas | $272.82 | $117.93 |
| Houston, TXTexas | $278.12 | $123.23 |
| Rest of TexasTexas | $263.73 | $115.71 |
| UtahUtah | $261.76 | $115.14 |
| VirginiaVirginia | $269.08 | $115.75 |
| Virgin Islands, VIUnited States Virgin Islands | $277.76 | $120.06 |
| VermontVermont | $268.64 | $114.22 |
| Rest of WashingtonWashington | $285.24 | $120.99 |
| King County, WAWashington | $324.86 | $133.47 |
| WisconsinWisconsin | $259.89 | $110.46 |
| West VirginiaWest Virginia | $251.77 | $116.22 |
| WyomingWyoming | $273.04 | $117.06 |
46220 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $311.30 | 1 |
| AL | $244.67 | 1 |
| AR | $240.77 | 1 |
| AZ | $267.55 | 1 |
| CA | $292.44–$371.17 | 29 |
| CO | $287.73 | 1 |
| CT | $295.07 | 1 |
| DC | $317.47 | 1 |
| DE | $272.28 | 1 |
| FL | $271.04–$299.12 | 3 |
| GA | $254.37–$281.08 | 2 |
| GU | $300.72 | 1 |
| HI | $300.72 | 1 |
| IA | $251.57 | 1 |
| ID | $253.38 | 1 |
| IL | $262.44–$289.54 | 4 |
| IN | $255.00 | 1 |
| KS | $250.26 | 1 |
| KY | $251.04 | 1 |
| LA | $250.61–$264.28 | 2 |
| MA | $285.74–$318.05 | 2 |
| MD | $277.85–$317.47 | 3 |
| ME | $254.82–$270.06 | 2 |
| MI | $258.24–$274.73 | 2 |
| MN | $274.93 | 1 |
| MO | $245.85–$265.33 | 3 |
| MS | $243.36 | 1 |
| MT | $275.54 | 1 |
| NC | $257.76 | 1 |
| ND | $269.80 | 1 |
| NE | $253.10 | 1 |
| NH | $283.10 | 1 |
| NJ | $298.23–$313.67 | 2 |
| NM | $259.79 | 1 |
| NV | $274.15 | 1 |
| NY | $262.01–$327.55 | 5 |
| OH | $257.07 | 1 |
| OK | $250.56 | 1 |
| OR | $271.83–$297.61 | 2 |
| PA | $257.52–$287.12 | 2 |
| PR | $277.76 | 1 |
| RI | $282.55 | 1 |
| SC | $257.88 | 1 |
| SD | $269.13 | 1 |
| TN | $251.65 | 1 |
| TX | $255.66–$286.94 | 8 |
| UT | $261.76 | 1 |
| VA | $269.08–$317.47 | 2 |
| VI | $277.76 | 1 |
| VT | $268.64 | 1 |
| WA | $285.24–$324.86 | 2 |
| WI | $259.89 | 1 |
| WV | $251.77 | 1 |
| WY | $273.04 | 1 |
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.
The exact South Dakota 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
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.57 | × 1.000 | 1.5700 |
| Practice expense | 6.39 | × 1.000 | 6.3900 |
| Malpractice | 0.29 | × 0.336 | 0.0974 |
| Total RVUs | 8.0574 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$269.13
Office: (1.57 × 1 + 6.39 × 1 + 0.29 × 0.336) × $33.4009 = $269.13
Facility: (1.57 × 1 + 1.72 × 1 + 0.29 × 0.336) × $33.4009 = $113.14
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%).
How 46220 has changed in South Dakota
46220 · Office / nonfacility
$269.13
Effective 2026-10-01
The base rate is $33.30 higher than on 2025-10-01, moving from $235.83 to $269.13 (14.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$235.83changed to$269.13
- 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
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$245.48changed to$235.83
- 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.
March 9, 2024
RVU24AR
$241.48changed to$245.48
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$250.61changed to$241.48
- 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
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$257.15changed to$250.61
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 5.72 changed to 5.68
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$251.13changed to$257.15
- 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.
January 1, 2021
RVU21A
$229.64changed to$251.13
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 4.65 changed to 5.49
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$217.34changed to$229.64
- 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
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$207.24changed to$217.34
- 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.
January 1, 2018
RVU18AR1
$204.51changed to$207.24
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.97 changed to 4.03
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$203.87changed to$204.51
- 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
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$205.54changed to$203.87
- 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.
July 1, 2015
RVU15C
$204.52changed to$205.54
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$203.50changed to$204.52
- 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
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$209.91changed to$203.50
- 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
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $209.91
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $269.13 | $113.14 | RVU26D |
| 2026-07-01 | $269.13 | $113.14 | RVU26C |
| 2026-04-01 | $269.13 | $113.14 | RVU26B |
| 2026-01-01 | $269.13 | $113.14 | RVU26A |
| 2025-10-01 | $235.83 | $113.88 | RVU25D |
| 2025-07-01 | $235.83 | $113.88 | RVU25C |
| 2025-04-01 | $235.83 | $113.88 | RVU25B |
| 2025-01-01 | $235.83 | $113.88 | RVU25A |
| 2024-10-01 | $245.48 | $116.33 | RVU24D |
| 2024-07-01 | $245.48 | $116.33 | RVU24C |
| 2024-04-01 | $245.48 | $116.33 | RVU24B |
| 2024-03-09 | $245.48 | $116.33 | RVU24AR |
| 2024-01-01 | $241.48 | $114.43 | RVU24A |
| 2023-10-01 | $250.61 | $117.10 | RVU23D |
| 2023-07-01 | $250.61 | $117.10 | RVU23C |
| 2023-04-01 | $250.61 | $117.10 | RVU23B |
| 2023-01-01 | $250.61 | $117.10 | RVU23A |
| 2022-10-01 | $257.15 | $117.68 | RVU22D |
| 2022-07-01 | $257.15 | $117.68 | RVU22C |
| 2022-04-01 | $257.15 | $117.68 | RVU22B |
| 2022-01-01 | $257.15 | $117.68 | RVU22A |
| 2021-10-01 | $251.13 | $117.14 | RVU21D |
| 2021-07-01 | $251.13 | $117.14 | RVU21C |
| 2021-04-01 | $251.13 | $117.14 | RVU21B |
| 2021-01-01 | $251.13 | $117.14 | RVU21A |
| 2020-10-01 | $229.64 | $117.40 | RVU20D |
| 2020-07-01 | $229.64 | $117.40 | RVU20C |
| 2020-04-01 | $229.64 | $117.40 | RVU20B |
| 2020-01-01 | $229.64 | $117.40 | RVU20A |
| 2019-10-01 | $217.34 | $117.15 | RVU19D |
| 2019-07-01 | $217.34 | $117.15 | RVU19C |
| 2019-04-01 | $217.34 | $117.15 | RVU19B |
| 2019-01-01 | $217.34 | $117.15 | RVU19A |
| 2018-10-01 | $207.24 | $116.52 | RVU18D |
| 2018-07-01 | $207.24 | $116.52 | RVU18C |
| 2018-04-01 | $207.24 | $116.52 | RVU18B |
| 2018-01-01 | $207.24 | $116.52 | RVU18AR1 |
| 2017-10-01 | $204.51 | $116.23 | RVU17D |
| 2017-07-01 | $204.51 | $116.23 | RVU17C |
| 2017-04-01 | $204.51 | $116.23 | RVU17B |
| 2017-01-01 | $204.51 | $116.23 | RVU17A |
| 2016-10-01 | $203.87 | $115.79 | RVU16D |
| 2016-07-01 | $203.87 | $115.79 | RVU16C |
| 2016-04-01 | $203.87 | $115.79 | RVU16B |
| 2016-01-01 | $203.87 | $115.79 | RVU16A |
| 2015-10-01 | $205.54 | $116.78 | RVU15D |
| 2015-07-01 | $205.54 | $116.78 | RVU15C |
| 2015-04-01 | $204.52 | $116.20 | RVU15B |
| 2015-01-01 | $204.52 | $116.20 | RVU15A |
| 2014-10-01 | $203.50 | $116.09 | RVU14D |
| 2014-07-01 | $203.50 | $116.09 | RVU14C |
| 2014-04-01 | $203.50 | $116.09 | RVU14B |
| 2014-01-01 | $203.50 | $116.09 | RVU14A |
| 2013-10-01 | $209.91 | $116.00 | RVU13D |
| 2013-07-01 | $209.91 | $116.00 | RVU13C |
| 2013-04-01 | $209.91 | $116.00 | RVU13B |
| 2013-01-01 | $209.91 | $116.00 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
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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