CPT code 46257: Hemorrhoidectomy, one group with fissurectomy2026 Medicare rate & RVUs in California
Report this operation when a surgeon excises one internal and external hemorrhoid group and performs a fissurectomy during the same session.
CMS doesn’t publish an office rate for 46257 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $428.13 |
| Chico, CA | Unavailable | $425.78 |
| El Centro, CA | Unavailable | $425.92 |
| Fresno, CA | Unavailable | $425.78 |
| Hanford, CA | Unavailable | $425.78 |
| Los Angeles, CA | Unavailable | $451.24 |
| Madera, CA | Unavailable | $425.78 |
| Marin County, CA | Unavailable | $501.48 |
| Merced, CA | Unavailable | $425.78 |
| Modesto, CA | Unavailable | $425.78 |
| Napa, CA | Unavailable | $478.30 |
| Oxnard, CA | Unavailable | $447.49 |
| Redding, CA | Unavailable | $425.78 |
| Rest of California | Unavailable | $425.78 |
| Riverside, CA | Unavailable | $434.55 |
| Sacramento, CA | Unavailable | $442.82 |
| Salinas, CA | Unavailable | $441.08 |
| San Benito County, CA | Unavailable | $512.81 |
| San Diego, CA | Unavailable | $448.49 |
| San Francisco, CA | Unavailable | $500.56 |
| San Luis Obispo, CA | Unavailable | $434.43 |
| Santa Clara County, CA | Unavailable | $509.05 |
| Santa Cruz, CA | Unavailable | $450.46 |
| Santa Maria, CA | Unavailable | $441.92 |
| Santa Rosa, CA | Unavailable | $454.76 |
| Stockton, CA | Unavailable | $425.78 |
| Vallejo, CA | Unavailable | $476.97 |
| Visalia, CA | Unavailable | $425.78 |
| Yuba City, CA | Unavailable | $425.78 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.09/0.81/0.10 | Share 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.
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%).
46257 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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