FeeBase
Log inGet started
Menu

CPT code 46257: Hemorrhoidectomy, one group with fissurectomy2026 Medicare rate & RVUs

Report this operation when a surgeon excises one internal and external hemorrhoid group and performs a fissurectomy during the same session.

CMS RVU26DEffective Oct 1, 2026109 payment localities54 Medicare services in 2024

Medicare pays $415.84 for 46257 nationally in a facility.

Medicare rate · 46257

Hemorrhoidectomy, one group with fissurectomy

Office or facility?

Work RVUs
5.62
Total RVUs
12.45
Global days
090

National rate · 2026

$415.84

Facility setting, before claim adjustments.

See every locality for 46257 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 46257 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 46257 covers

This operation removes one hemorrhoidal group with both internal and external components and includes excision of an anal fissure. It is typically performed by a colorectal or general surgeon in an operating room, with the operative report documenting the treated hemorrhoid group and the fissurectomy performed during the operation.

Choose this code when the work includes both the single-group hemorrhoidectomy and fissurectomy; a fissure’s presence alone does not support reporting the combined procedure if fissurectomy was not performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% 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.

Where 46257 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

46257 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$378.97
AlaskaUnavailable$510.62
ArizonaUnavailable$405.71
ArkansasUnavailable$374.37
Atlanta, GAUnavailable$425.06
Austin, TXUnavailable$424.79
Bakersfield, CAUnavailable$428.13
Baltimore area, MDUnavailable$439.93
Beaumont, TXUnavailable$395.82
Brazoria, TXUnavailable$409.58

46257 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.

View every state and territory as a table
46257 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 46257 rate is calculated

Each of 46257’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 · 46257

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.62

5.62 RVUs× 1.000 GPCI

Practice expense6.02

6.02 RVUs× 1.000 GPCI

Malpractice0.81

0.81 RVUs× 1.000 GPCI

Adjusted RVUs

12.4500

Conversion factor

$33.4009

Medicare rate

$415.84

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

Payment rules and modifiers for 46257

46257 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46257

Hemorrhoidectomy, one group with fissurectomy

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 · 46257

Hemorrhoidectomy, one group with fissurectomy

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

46257 without 51 · national facility

$415.84

Hemorrhoidectomy, one group with fissurectomy

46257-51 · Second procedure: 50%

$207.92

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

46257 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 46257

    Hemorrhoidectomy, one group with fissurectomy5.62 wRVU

    Not priced

  • 46255

    Hemorrhoidectomy, one internal and external group4.84 wRVU

    $580.84

  • 46261

    Hemorrhoidectomy, multiple groups with fissurectomy7.57 wRVU

    Not priced

  • 46258

    Hemorrhoidectomy, single group with fistulectomy6.25 wRVU

    Not priced

  • 46200

    Fissure surgery, fissure excision3.5 wRVU

    $530.74

How to choose

46255HemorrhoidectomyOne internal and external group
Both address one internal and external hemorrhoid group; choose 46257 when fissurectomy is also performed, and 46255 when it is not.
46261HemorrhoidectomyMultiple groups with fissurectomy
Both include fissurectomy, but 46261 is for multiple hemorrhoid groups rather than one.
46258HemorrhoidectomySingle group with fistulectomy
46258 combines hemorrhoid surgery with treatment of an anal fistula; 46257 combines one-group hemorrhoidectomy with fissurectomy.
46200Fissure surgeryFissure excision
46200 covers fissure removal without the combined hemorrhoidectomy. Use 46257 when the operation also removes one internal and external hemorrhoid group.

Codes related to 46257

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

Codes related to 46257
CodeHow it relatesNational office range
Used instead
46255Hemorrhoidectomy, one internal and external groupOne internal and external hemorrhoid group without the fissurectomy.$511.28–$756.36
46260Hemorrhoidectomy, internal and external, 2+ groupsMultiple internal and external hemorrhoid groups without fissurectomy.No office rate
46200Fissure surgery, fissure excisionAnal fissure removal when hemorrhoidectomy is not part of the operation.$465.50–$708.36
46258Hemorrhoidectomy, single group with fistulectomyCombined hemorrhoid and fistula operation rather than hemorrhoidectomy with fissurectomy.No office rate
46221Hemorrhoid ligation, rubber-band techniqueHemorrhoid ligation is a different treatment approach for internal hemorrhoids.$286.44–$433.20
Same family
46261Hemorrhoidectomy, multiple groups with fissurectomyMultiple internal and external hemorrhoid groups with fissurectomy.No office rate

46257 billing questions

How does this differ from 46255?

46257 includes fissurectomy with excision of one internal and external hemorrhoid group. 46255 describes the one-group hemorrhoidectomy without the fissurectomy.

Can the fissurectomy be billed separately?

The fissurectomy is included in this combined procedure. Do not separately report it as though it were an independent service performed during the same operation.

When is 46261 more appropriate?

Use 46261 when the operation treats multiple internal and external hemorrhoid groups and includes fissurectomy. This code is for one group with fissurectomy.

Should modifier 50 be appended?

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

How does the global period affect postoperative claims?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. 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 46257PPRRVU2026_Oct_nonQPP.csv, line 5,585 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 46257 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 46257 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist