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CPT code 46221: Hemorrhoid ligation, rubber-band technique2026 Medicare rate & RVUs in Vermont

Reports office or facility treatment of internal hemorrhoids by placing rubber bands around hemorrhoidal tissue to reduce its blood supply.

CMS RVU26DEffective Oct 1, 2026One payment locality68.8K Medicare services in 2024

In Vermont, Medicare pays $317.35 for 46221 in the office and $190.04 when it’s performed in a hospital or facility.

$317.35Office (non-facility)
$190.04Hospital or facility
−2.6%vs the national office rate ($325.66)

Check a contract rate as a % of Medicare · 46221 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 46221 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 46221 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 46221 covers

This procedure treats internal hemorrhoids by placing a tight rubber band around the base of hemorrhoidal tissue, typically with an anoscope for visualization. Colorectal surgeons, general surgeons, and gastroenterologists commonly perform it in an outpatient office or facility for symptomatic internal hemorrhoids, such as those causing bleeding or prolapse. The service is for ligation by rubber band, not removal of external hemorrhoids or excision of hemorrhoidal tissue.

Report 46221 for the band-ligation service, including when more than one internal hemorrhoid is treated in the session; document the indication, internal site, technique, and treated tissue. Related postoperative visits for 10 days are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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-surgeon and team-surgery billing 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 Vermont compares for 46221

Across 109 of 109 payment localities, the office rate for 46221 runs from $286.44 in Arkansas to $433.20 in San Benito County, CA. Vermont pays $317.35. The RVUs are the same everywhere; the geographic indexes change the dollars.

46221 in Vermont vs other payment areas
  1. Vermont · this page$317.35
  2. Los Angeles, CA · California$368.10+$50.75
  3. Washington, DC area · District of Columbia$373.32+$55.97
  4. Miami, FL · Florida$353.75+$36.40
  5. Chicago, IL · Illinois$342.95+$25.60
  6. Manhattan, NY · New York$375.99+$58.64
  7. Alaska · Alaska$374.06+$56.71

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

Every other payment area

46221 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$290.84$178.32
ArkansasArkansas$286.44$175.97
ArizonaArizona$316.59$191.98
Bakersfield, CACalifornia$345.15$204.21
Chico, CACalifornia$344.12$203.18
El Centro, CACalifornia$344.18$203.24
Fresno, CACalifornia$344.12$203.18
Hanford, CACalifornia$344.12$203.18

46221 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.

$286.44

$388.66

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

View every state and territory as a table
46221 office rate range by state
State / territoryOffice rate rangeLocalities
AK$374.061
AL$290.841
AR$286.441
AZ$316.591
CA$344.12–$433.2029
CO$339.101
CT$347.951
DC$373.321
DE$321.991
FL$321.29–$353.753
GA$302.39–$332.102
GU$353.041
HI$353.041
IA$298.281
ID$300.381
IL$311.83–$342.954
IN$302.191
KS$296.961
KY$298.351
LA$297.92–$313.322
MA$337.00–$373.432
MD$328.28–$373.323
ME$302.17–$319.092
MI$306.61–$325.622
MN$324.061
MO$292.67–$314.323
MS$289.601
MT$325.631
NC$305.451
ND$318.521
NE$299.951
NH$333.871
NJ$351.68–$369.212
NM$308.421
NV$323.891
NY$310.25–$385.645
OH$305.151
OK$297.641
OR$321.14–$350.102
PA$305.58–$339.072
PR$328.081
RI$333.631
SC$305.861
SD$317.671
TN$298.541
TX$303.49–$338.188
UT$310.221
VA$318.10–$373.322
VI$328.081
VT$317.351
WA$336.33–$381.062
WI$307.391
WV$299.821
WY$322.531

See 46221 in every payment locality

How the 46221 rate is calculated

Each of 46221’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 · 46221

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.30

2.30 RVUs× 1.000 GPCI

Practice expense7.09

7.09 RVUs× 1.000 GPCI

Malpractice0.36

0.36 RVUs× 1.000 GPCI

Adjusted RVUs

9.7500

Conversion factor

$33.4009

Medicare rate

$325.66

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Vermont inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,581

Code
46221
Physician work
2.30
Practice expense
7.09
Malpractice
0.36

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 46221 in Vermont
ComponentRVULocality factorAdjusted
Physician work2.30× 1.0002.3000
Practice expense7.09× 0.9907.0191
Malpractice0.36× 0.5060.1822
Total RVUs9.5013
Conversion factor× 33.4009

Office rate, Vermont$317.35

Office: (2.3 × 1 + 7.09 × 0.99 + 0.36 × 0.506) × $33.4009 = $317.35

Facility: (2.3 × 1 + 3.24 × 0.99 + 0.36 × 0.506) × $33.4009 = $190.04

Open 46221 in the RVU calculator

Payment rules and modifiers for 46221

46221 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46221

Hemorrhoid ligation, rubber-band technique

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 · 46221

Hemorrhoid ligation, rubber-band technique

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

46221 without 51 · national office

$325.66

Hemorrhoid ligation, rubber-band technique

46221-51 · Second procedure: 50%

$162.83

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 46221

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

Codes related to 46221
CodeHow it relatesOffice range, Vermont
Used instead
46945Hemorrhoid ligation, one column, no imagingInternal hemorrhoid ligation using a method other than rubber bands for a single hemorrhoid group.No office rate
46946Hemorrhoid ligation, two or more, without imagingInternal hemorrhoid ligation using a method other than rubber bands for multiple groups.No office rate
46930Hemorrhoid treatment, thermal energyTreats internal hemorrhoids by thermal destruction rather than rubber-band ligation.$242.32
46255Hemorrhoidectomy, one internal and external groupExcisional treatment of one internal and external hemorrhoid group rather than band ligation.$561.94
46260Hemorrhoidectomy, internal and external, 2+ groupsExcisional treatment of multiple internal and external hemorrhoid groups rather than band ligation.No office rate

How 46221 has changed in Vermont

46221 · Office / nonfacility

$317.35

Effective 2026-10-01

The base rate is $45.47 higher than on 2025-10-01, moving from $271.88 to $317.35 (16.7%).

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

    $271.88changed to$317.35

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.36 changed to 2.30
    • Practice expense RVU 5.90 changed to 7.09
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $276.97changed to$271.88

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.82 changed to 5.90
    • Malpractice RVU 0.35 changed to 0.36

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $272.45changed to$276.97

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $283.38changed to$272.45

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.83 changed to 5.82
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $293.09changed to$283.38

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.91 changed to 5.83
    • Malpractice RVU 0.34 changed to 0.35
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $295.32changed to$293.09

    • Conversion factor 34.8931 changed to 34.6062
    • Malpractice RVU 0.33 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $279.60changed to$295.32

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.16 changed to 5.91
    • Malpractice RVU 0.32 changed to 0.33
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $277.50changed to$279.60

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.05 changed to 5.16
    • Malpractice RVU 0.36 changed to 0.32
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $275.37changed to$277.50

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.00 changed to 5.05

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $271.88changed to$275.37

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.93 changed to 5.00
    • Malpractice RVU 0.37 changed to 0.36
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $270.39changed to$271.88

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.92 changed to 4.93
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $274.26changed to$270.39

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.00 changed to 4.92

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $272.89changed to$274.26

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $267.96changed to$272.89

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.85 changed to 5.00
    • Malpractice RVU 0.39 changed to 0.37
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$267.96

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$317.35$190.04RVU26D
2026-07-01$317.35$190.04RVU26C
2026-04-01$317.35$190.04RVU26B
2026-01-01$317.35$190.04RVU26A
2025-10-01$271.88$184.19RVU25D
2025-07-01$271.88$184.19RVU25C
2025-04-01$271.88$184.19RVU25B
2025-01-01$271.88$184.19RVU25A
2024-10-01$276.97$186.73RVU24D
2024-07-01$276.97$186.73RVU24C
2024-04-01$276.97$186.73RVU24B
2024-03-09$276.97$186.73RVU24AR
2024-01-01$272.45$183.68RVU24A
2023-10-01$283.38$189.80RVU23D
2023-07-01$283.38$189.80RVU23C
2023-04-01$283.38$189.80RVU23B
2023-01-01$283.38$189.80RVU23A
2022-10-01$293.09$195.06RVU22D
2022-07-01$293.09$195.06RVU22C
2022-04-01$293.09$195.06RVU22B
2022-01-01$293.09$195.06RVU22A
2021-10-01$295.32$194.73RVU21D
2021-07-01$295.32$194.73RVU21C
2021-04-01$295.32$194.73RVU21B
2021-01-01$295.32$194.73RVU21A
2020-10-01$279.60$195.21RVU20D
2020-07-01$279.60$195.21RVU20C
2020-04-01$279.60$195.21RVU20B
2020-01-01$279.60$195.21RVU20A
2019-10-01$277.50$194.83RVU19D
2019-07-01$277.50$194.83RVU19C
2019-04-01$277.50$194.83RVU19B
2019-01-01$277.50$194.83RVU19A
2018-10-01$275.37$193.88RVU18D
2018-07-01$275.37$193.88RVU18C
2018-04-01$275.37$193.88RVU18B
2018-01-01$275.37$193.88RVU18AR1
2017-10-01$271.88$192.86RVU17D
2017-07-01$271.88$192.86RVU17C
2017-04-01$271.88$192.86RVU17B
2017-01-01$271.88$192.86RVU17A
2016-10-01$270.39$192.03RVU16D
2016-07-01$270.39$192.03RVU16C
2016-04-01$270.39$192.03RVU16B
2016-01-01$270.39$192.03RVU16A
2015-10-01$274.26$194.89RVU15D
2015-07-01$274.26$194.89RVU15C
2015-04-01$272.89$193.92RVU15B
2015-01-01$272.89$193.92RVU15A
2014-10-01$267.96$190.84RVU14D
2014-07-01$267.96$190.84RVU14C
2014-04-01$267.96$190.84RVU14B
2014-01-01$267.96$190.84RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46221 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

46221 billing questions

Does 46221 cover one band or multiple bands?

The code covers rubber-band ligation of internal hemorrhoid tissue, including when multiple sites are treated in the session. Document the treated internal tissue and technique rather than reporting a separate unit for each band.

How is this different from excisional hemorrhoidectomy?

46221 describes rubber-band ligation of internal hemorrhoids. Codes such as 46255 and 46260 describe excision, with the applicable code depending on the tissue and extent removed.

Are related postoperative visits separately reported?

Related postoperative visits during the 10-day global period are included in 46221.

Can modifier 50 be used when hemorrhoids are treated on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

How does Medicare handle other procedures performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50% when performed in the same session.

Can an assistant or co-surgeon be billed for the ligation?

Medicare does not pay an assistant at surgery for 46221. Co-surgeon and team-surgery billing 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 46221PPRRVU2026_Oct_nonQPP.csv, line 5,581 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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