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CPT code 46250: Hemorrhoidectomy, external, two or more groups2026 Medicare rate & RVUs in Nevada

Reports excisional surgery for external hemorrhoids involving two or more groups, rather than a single group or internal-and-external disease.

CMS RVU26DEffective Oct 1, 2026One payment locality868 Medicare services in 2024

In Nevada, Medicare pays $532.44 for 46250 in the office and $314.11 when it’s performed in a hospital or facility.

$532.44Office (non-facility)
$314.11Hospital or facility
−0.8%vs the national office rate ($536.75)

Check a contract rate as a % of Medicare · 46250 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 46250 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nevada
  2. What 46250 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 46250 covers

This code describes operative excision of external hemorrhoids in two or more groups. It is typically performed by a colorectal or general surgeon for symptomatic external hemorrhoidal disease requiring removal, often in a surgical facility. The operative report should identify the external disease treated and document excision involving multiple groups; a procedure limited to anal tags or to hemorrhoid ligation is a different service.

Report the code once for the qualifying excision, not once per group. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. If 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 for this code. 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 Nevada compares for 46250

Across 109 of 109 payment localities, the office rate for 46250 runs from $470.92 in Arkansas to $702.67 in San Benito County, CA. Nevada pays $532.44. The RVUs are the same everywhere; the geographic indexes change the dollars.

46250 in Nevada vs other payment areas
  1. Nevada · this page$532.44
  2. Los Angeles, CA · California$600.78+$68.34
  3. Washington, DC area · District of Columbia$613.32+$80.88
  4. Miami, FL · Florida$594.84+$62.40
  5. Chicago, IL · Illinois$575.91+$43.47
  6. Manhattan, NY · New York$622.05+$89.61
  7. Alaska · Alaska$617.37+$84.93

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

Every other payment area

46250 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$478.27$287.43
ArkansasArkansas$470.92$283.56
ArizonaArizona$521.23$309.88
Bakersfield, CACalifornia$563.97$324.92
Chico, CACalifornia$561.64$322.60
El Centro, CACalifornia$561.79$322.74
Fresno, CACalifornia$561.64$322.60
Hanford, CACalifornia$561.64$322.60

46250 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.

$470.92

$632.16

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

View every state and territory as a table
46250 office rate range by state
State / territoryOffice rate rangeLocalities
AK$617.371
AL$478.271
AR$470.921
AZ$521.231
CA$561.64–$702.6729
CO$555.971
CT$573.931
DC$613.321
DE$530.171
FL$534.57–$594.843
GA$502.13–$548.732
GU$575.691
HI$575.691
IA$488.351
ID$492.331
IL$520.32–$575.914
IN$495.291
KS$487.281
KY$493.251
LA$492.98–$518.712
MA$552.90–$611.202
MD$540.28–$613.323
ME$496.51–$523.072
MI$508.15–$543.032
MN$527.741
MO$484.91–$519.033
MS$477.941
MT$536.701
NC$501.811
ND$520.091
NE$490.781
NH$548.431
NJ$579.08–$606.642
NM$511.651
NV$532.441
NY$509.90–$639.665
OH$504.751
OK$490.861
OR$526.94–$572.902
PA$504.84–$559.842
PR$540.411
RI$548.571
SC$504.391
SD$518.121
TN$490.051
TX$501.42–$555.318
UT$511.671
VA$522.21–$613.322
VI$540.411
VT$519.191
WA$551.48–$622.622
WI$501.781
WV$500.321
WY$529.461

See 46250 in every payment locality

How the 46250 rate is calculated

Each of 46250’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 · 46250

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.14

4.14 RVUs× 1.000 GPCI

Practice expense11.09

11.09 RVUs× 1.000 GPCI

Malpractice0.84

0.84 RVUs× 1.000 GPCI

Adjusted RVUs

16.0700

Conversion factor

$33.4009

Medicare rate

$536.75

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

The exact Nevada inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,583

Code
46250
Physician work
4.14
Practice expense
11.09
Malpractice
0.84

GPCI2026.csv

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 46250 in Nevada
ComponentRVULocality factorAdjusted
Physician work4.14× 1.0004.1400
Practice expense11.09× 1.00111.1011
Malpractice0.84× 0.8330.6997
Total RVUs15.9408
Conversion factor× 33.4009

Office rate, Nevada$532.44

Office: (4.14 × 1 + 11.09 × 1.001 + 0.84 × 0.833) × $33.4009 = $532.44

Facility: (4.14 × 1 + 4.56 × 1.001 + 0.84 × 0.833) × $33.4009 = $314.11

Open 46250 in the RVU calculator

Payment rules and modifiers for 46250

46250 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46250

Hemorrhoidectomy, external, two or more groups

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 46250

Hemorrhoidectomy, external, two or more groups

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46250 without 51 · national office

$536.75

Hemorrhoidectomy, external, two or more groups

46250-51 · Second procedure: 50%

$268.38

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 46250

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

Codes related to 46250
CodeHow it relatesOffice range, Nevada
Same family
46255Hemorrhoidectomy, one internal and external groupHemorrhoidectomy involving internal and external disease in one group.$576.15
46260Hemorrhoidectomy, internal and external, 2+ groupsHemorrhoidectomy involving internal and external disease in two or more groups.No office rate
Used instead
46221Hemorrhoid ligation, rubber-band techniqueLigation is a different treatment for hemorrhoids, rather than excision of multiple external groups.$323.89
46230Anal tag excision, multiple tagsFor excision of multiple anal tags, not hemorrhoidectomy of multiple external groups.$339.92

How 46250 has changed in Nevada

46250 · Office / nonfacility

$532.44

Effective 2026-10-01

The base rate is $67.55 higher than on 2025-10-01, moving from $464.89 to $532.44 (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

    $464.89changed to$532.44

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.25 changed to 4.14
    • Practice expense RVU 9.43 changed to 11.09
    • Malpractice RVU 0.82 changed to 0.84
    • Practice expense GPCI 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $475.41changed to$464.89

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.34 changed to 9.43

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $467.66changed to$475.41

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $490.94changed to$467.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.37 changed to 9.34
    • Malpractice RVU 0.79 changed to 0.82
    • Malpractice GPCI 1.098 changed to 0.844

  5. January 1, 2023

    RVU23A

    $511.88changed to$490.94

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.48 changed to 9.37
    • Malpractice RVU 0.77 changed to 0.79
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $515.18changed to$511.88

    • Conversion factor 34.8931 changed to 34.6062
    • Malpractice RVU 0.75 changed to 0.77

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $495.86changed to$515.18

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.58 changed to 9.48
    • Malpractice RVU 0.79 changed to 0.75
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $487.11changed to$495.86

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.37 changed to 8.58
    • Malpractice RVU 0.82 changed to 0.79
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $483.17changed to$487.11

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.25 changed to 8.37
    • Malpractice RVU 0.85 changed to 0.82

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $484.06changed to$483.17

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.14 changed to 8.25
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $490.18changed to$484.06

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.88 changed to 0.85
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $492.02changed to$490.18

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.17 changed to 8.14
    • Malpractice RVU 0.85 changed to 0.88

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $489.58changed to$492.02

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $485.68changed to$489.58

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.00 changed to 8.17
    • Malpractice RVU 0.78 changed to 0.85
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $502.58changed to$485.68

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.99 changed to 8.00
    • Malpractice RVU 0.82 changed to 0.78
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$502.58

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$532.44$314.11RVU26D
2026-07-01$532.44$314.11RVU26C
2026-04-01$532.44$314.11RVU26B
2026-01-01$532.44$314.11RVU26A
2025-10-01$464.89$311.56RVU25D
2025-07-01$464.89$311.56RVU25C
2025-04-01$464.89$311.56RVU25B
2025-01-01$464.89$311.56RVU25A
2024-10-01$475.41$316.30RVU24D
2024-07-01$475.41$316.30RVU24C
2024-04-01$475.41$316.30RVU24B
2024-03-09$475.41$316.30RVU24AR
2024-01-01$467.66$311.14RVU24A
2023-10-01$490.94$327.26RVU23D
2023-07-01$490.94$327.26RVU23C
2023-04-01$490.94$327.26RVU23B
2023-01-01$490.94$327.26RVU23A
2022-10-01$511.88$340.23RVU22D
2022-07-01$511.88$340.23RVU22C
2022-04-01$511.88$340.23RVU22B
2022-01-01$511.88$340.23RVU22A
2021-10-01$515.18$339.67RVU21D
2021-07-01$515.18$339.67RVU21C
2021-04-01$515.18$339.67RVU21B
2021-01-01$515.18$339.67RVU21A
2020-10-01$495.86$335.98RVU20D
2020-07-01$495.86$335.98RVU20C
2020-04-01$495.86$335.98RVU20B
2020-01-01$495.86$335.98RVU20A
2019-10-01$487.11$329.14RVU19D
2019-07-01$487.11$329.14RVU19C
2019-04-01$487.11$329.14RVU19B
2019-01-01$487.11$329.14RVU19A
2018-10-01$483.17$327.93RVU18D
2018-07-01$483.17$327.93RVU18C
2018-04-01$483.17$327.93RVU18B
2018-01-01$483.17$327.93RVU18AR1
2017-10-01$484.06$329.69RVU17D
2017-07-01$484.06$329.69RVU17C
2017-04-01$484.06$329.69RVU17B
2017-01-01$484.06$329.69RVU17A
2016-10-01$490.18$333.26RVU16D
2016-07-01$490.18$333.26RVU16C
2016-04-01$490.18$333.26RVU16B
2016-01-01$490.18$333.26RVU16A
2015-10-01$492.02$333.03RVU15D
2015-07-01$492.02$333.03RVU15C
2015-04-01$489.58$331.37RVU15B
2015-01-01$489.58$331.37RVU15A
2014-10-01$485.68$331.10RVU14D
2014-07-01$485.68$331.10RVU14C
2014-04-01$485.68$331.10RVU14B
2014-01-01$485.68$331.10RVU14A
2013-10-01$502.58$335.91RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46250 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

46250 billing questions

When is this code appropriate instead of 46255?

Use this code for excision of external hemorrhoids involving two or more groups. Code 46255 describes combined internal and external hemorrhoidectomy involving one group.

How does this differ from 46260?

Both describe hemorrhoidectomy involving two or more groups, but 46260 includes internal and external disease. This code is for external hemorrhoids.

Should the code be reported once for each group removed?

No. Report one unit for the qualifying excisional procedure; document that two or more external groups were treated.

Can modifier 50 be used when disease is on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code because its descriptor or anatomy makes modifier 50 unsuitable.

Are postoperative visits separately reported?

Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. 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 46250PPRRVU2026_Oct_nonQPP.csv, line 5,583 (RVU26D)
Geographic factors for NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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