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CPT code 46230: Anal tag excision, multiple tags2026 Medicare rate & RVUs in Washington, DC area

Excision of multiple anal skin tags is reported when a clinician surgically removes more than one symptomatic tag from the anal area.

CMS RVU26DEffective Oct 1, 2026One payment locality973 Medicare services in 2024

In Washington, DC area, Medicare pays $391.70 for 46230 in the office and $184.34 when it’s performed in a hospital or facility.

$391.70Office (non-facility)
$184.34Hospital or facility
+14.4%vs the national office rate ($342.36)

Check a contract rate as a % of Medicare · 46230 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 46230 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 46230 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 46230 covers

This procedure removes multiple external anal skin tags, which are folds of skin that may cause irritation or make hygiene difficult. A colorectal surgeon or other qualified clinician typically performs the excision in an office or outpatient surgical setting, using local or other appropriate anesthesia. The operative work is directed at the tags themselves, rather than removal of hemorrhoidal tissue or treatment of a fissure.

Report 46230 when multiple anal tags are excised; the operative note should identify the tags removed and document the procedure performed. A single anal papilla or tag is represented by the related single-tag code, 46220. The service has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% 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 Washington, DC area compares for 46230

Across 109 of 109 payment localities, the office rate for 46230 runs from $300.58 in Arkansas to $450.88 in San Benito County, CA. Washington, DC area pays $391.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

46230 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$391.70
  2. Los Angeles, CA · California$384.60−$7.10
  3. Miami, FL · Florida$376.76−$14.94
  4. Chicago, IL · Illinois$364.92−$26.78
  5. Manhattan, NY · New York$396.27+$4.57
  6. Alaska · Alaska$393.42+$1.72
  7. Alabama · Alabama$305.26−$86.44

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

46230 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$300.58$149.38
ArizonaArizona$332.57$162.01
Bakersfield, CACalifornia$360.86$167.94
Chico, CACalifornia$359.52$166.60
El Centro, CACalifornia$359.60$166.68
Fresno, CACalifornia$359.52$166.60
Hanford, CACalifornia$359.52$166.60
Madera, CACalifornia$359.52$166.60

46230 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.

$300.58

$405.20

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

View every state and territory as a table
46230 office rate range by state
State / territoryOffice rate rangeLocalities
AK$393.421
AL$305.261
AR$300.581
AZ$332.571
CA$359.52–$450.8829
CO$355.301
CT$366.001
DC$391.701
DE$338.271
FL$339.81–$376.763
GA$319.39–$349.702
GU$368.651
HI$368.651
IA$312.191
ID$314.621
IL$330.41–$364.924
IN$316.511
KS$311.261
KY$314.231
LA$313.95–$330.312
MA$353.25–$390.872
MD$344.79–$391.703
ME$317.01–$334.272
MI$323.45–$344.922
MN$338.071
MO$308.66–$330.823
MS$304.651
MT$342.331
NC$320.411
ND$332.841
NE$313.821
NH$350.241
NJ$369.51–$387.402
NM$325.571
NV$339.921
NY$325.54–$407.135
OH$321.511
OK$312.981
OR$336.63–$366.392
PA$321.70–$356.872
PR$344.771
RI$350.201
SC$321.631
SD$331.711
TN$312.991
TX$319.52–$354.698
UT$326.251
VA$333.55–$391.702
VI$344.771
VT$332.031
WA$352.42–$398.432
WI$321.141
WV$317.681
WY$338.191

See 46230 in every payment locality

How the 46230 rate is calculated

Each of 46230’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 · 46230

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.55

2.55 RVUs× 1.000 GPCI

Practice expense7.22

7.22 RVUs× 1.000 GPCI

Malpractice0.48

0.48 RVUs× 1.000 GPCI

Adjusted RVUs

10.2500

Conversion factor

$33.4009

Medicare rate

$342.36

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

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,582

Code
46230
Physician work
2.55
Practice expense
7.22
Malpractice
0.48

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 46230 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.55× 1.0542.6877
Practice expense7.22× 1.1788.5052
Malpractice0.48× 1.1130.5342
Total RVUs11.7271
Conversion factor× 33.4009

Office rate, Washington, DC area$391.70

Office: (2.55 × 1.054 + 7.22 × 1.178 + 0.48 × 1.113) × $33.4009 = $391.70

Facility: (2.55 × 1.054 + 1.95 × 1.178 + 0.48 × 1.113) × $33.4009 = $184.34

Open 46230 in the RVU calculator

Payment rules and modifiers for 46230

46230 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46230

Anal tag excision, multiple tags

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 · 46230

Anal tag excision, multiple tags

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

46230 without 51 · national office

$342.36

Anal tag excision, multiple tags

46230-51 · Second procedure: 50%

$171.18

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 46230

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

Codes related to 46230
CodeHow it relatesOffice range, Washington, DC area
Same family
46220Anal tag excision, single external tagRelated excision code for a single anal papilla or tag.$317.47
Used instead
46250Hemorrhoidectomy, external, two or more groupsApplies to excision of multiple external hemorrhoid groups, not skin tags.$613.32
46255Hemorrhoidectomy, one internal and external groupApplies when one internal and external hemorrhoid group is excised.$662.21
46221Hemorrhoid ligation, rubber-band techniqueHemorrhoid ligation is used for hemorrhoidal disease rather than excision of anal tags.$373.32

How 46230 has changed in Washington, DC area

46230 · Office / nonfacility

$391.70

Effective 2026-10-01

The base rate is $42.63 higher than on 2025-10-01, moving from $349.07 to $391.70 (12.2%).

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

    $349.07changed to$391.70

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.62 changed to 2.55
    • Practice expense RVU 6.25 changed to 7.22
    • Malpractice RVU 0.49 changed to 0.48
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $362.02changed to$349.07

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.34 changed to 6.25
    • Malpractice RVU 0.47 changed to 0.49

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $356.11changed to$362.02

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $373.34changed to$356.11

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.35 changed to 6.34
    • Malpractice RVU 0.44 changed to 0.47
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $387.27changed to$373.34

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.38 changed to 6.35
    • Malpractice RVU 0.42 changed to 0.44
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $381.89changed to$387.27

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.16 changed to 6.38
    • Malpractice RVU 0.44 changed to 0.42

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $356.14changed to$381.89

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.35 changed to 6.16
    • Malpractice RVU 0.46 changed to 0.44
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $338.03changed to$356.14

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.02 changed to 5.35
    • Malpractice RVU 0.47 changed to 0.46
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $326.84changed to$338.03

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.76 changed to 5.02
    • Malpractice RVU 0.48 changed to 0.47

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $324.12changed to$326.84

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.71 changed to 4.76
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $323.37changed to$324.12

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.70 changed to 4.71
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $324.94changed to$323.37

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.72 changed to 4.70
    • Malpractice RVU 0.47 changed to 0.48

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $323.32changed to$324.94

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $321.21changed to$323.32

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.71 changed to 4.72
    • Malpractice RVU 0.46 changed to 0.47
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $326.36changed to$321.21

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.26 changed to 4.71
    • Malpractice RVU 0.48 changed to 0.46
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $326.36

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$391.70$184.34RVU26D
2026-07-01$391.70$184.34RVU26C
2026-04-01$391.70$184.34RVU26B
2026-01-01$391.70$184.34RVU26A
2025-10-01$349.07$192.15RVU25D
2025-07-01$349.07$192.15RVU25C
2025-04-01$349.07$192.15RVU25B
2025-01-01$349.07$192.15RVU25A
2024-10-01$362.02$195.77RVU24D
2024-07-01$362.02$195.77RVU24C
2024-04-01$362.02$195.77RVU24B
2024-03-09$362.02$195.77RVU24AR
2024-01-01$356.11$192.57RVU24A
2023-10-01$373.34$199.33RVU23D
2023-07-01$373.34$199.33RVU23C
2023-04-01$373.34$199.33RVU23B
2023-01-01$373.34$199.33RVU23A
2022-10-01$387.27$202.91RVU22D
2022-07-01$387.27$202.91RVU22C
2022-04-01$387.27$202.91RVU22B
2022-01-01$387.27$202.91RVU22A
2021-10-01$381.89$203.34RVU21D
2021-07-01$381.89$203.34RVU21C
2021-04-01$381.89$203.34RVU21B
2021-01-01$381.89$203.34RVU21A
2020-10-01$356.14$204.99RVU20D
2020-07-01$356.14$204.99RVU20C
2020-04-01$356.14$204.99RVU20B
2020-01-01$356.14$204.99RVU20A
2019-10-01$338.03$202.54RVU19D
2019-07-01$338.03$202.54RVU19C
2019-04-01$338.03$202.54RVU19B
2019-01-01$338.03$202.54RVU19A
2018-10-01$326.84$202.34RVU18D
2018-07-01$326.84$202.34RVU18C
2018-04-01$326.84$202.34RVU18B
2018-01-01$326.84$202.34RVU18AR1
2017-10-01$324.12$201.74RVU17D
2017-07-01$324.12$201.74RVU17C
2017-04-01$324.12$201.74RVU17B
2017-01-01$324.12$201.74RVU17A
2016-10-01$323.37$201.27RVU16D
2016-07-01$323.37$201.27RVU16C
2016-04-01$323.37$201.27RVU16B
2016-01-01$323.37$201.27RVU16A
2015-10-01$324.94$202.83RVU15D
2015-07-01$324.94$202.83RVU15C
2015-04-01$323.32$201.83RVU15B
2015-01-01$323.32$201.83RVU15A
2014-10-01$321.21$199.79RVU14D
2014-07-01$321.21$199.79RVU14C
2014-04-01$321.21$199.79RVU14B
2014-01-01$321.21$199.79RVU14A
2013-10-01$326.36$196.74RVU13D
2013-07-01$326.36$196.74RVU13C
2013-04-01$326.36$196.74RVU13B
2013-01-01$326.36$196.74RVU13AR

Price 46230 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

46230 billing questions

When should 46230 be selected instead of 46220?

Use 46230 when multiple anal tags are excised. Code 46220 represents excision of a single anal papilla or tag.

Can anal tag excision be reported as hemorrhoid removal?

No. 46230 describes removal of multiple skin tags; hemorrhoidectomy codes apply when hemorrhoidal tissue is excised. The operative note should make clear which tissue was treated.

Are related postoperative visits separately payable during the global period?

Related postoperative visits for 10 days are included in the global period for 46230.

Should modifier 50 be appended for tags on both sides?

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

How are other procedures performed in the same session paid?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard 50% multiple-procedure reduction.

Can an assistant or co-surgeon be billed for 46230?

Medicare does not pay an assistant at surgery for this code. 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 46230PPRRVU2026_Oct_nonQPP.csv, line 5,582 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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