CPT code 46258: Hemorrhoidectomy, single group with fistulectomy2026 Medicare rate & RVUs in California
Reports excision of one internal and external hemorrhoid group together with fistulectomy during the same operative session.
CMS doesn’t publish an office rate for 46258 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.
Your location
On this page 9 sections
What 46258 covers
This service combines excision of one internal and external hemorrhoid group with surgical removal of an anal fistula. It is typically performed by a colorectal surgeon or general surgeon in an operating room or ambulatory surgery center when both conditions are treated in the same operation. The hemorrhoid component is limited to one column or group; the fistulectomy is part of the service described by this code.
Select this code when the operative report supports treatment of one hemorrhoid group and fistulectomy, rather than fissurectomy or treatment of multiple groups. Document the hemorrhoid site and extent, the fistula treated, and the procedures actually performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and additional procedures at 50%. Modifier 50 is inappropriate for this single-group service. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment 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 46258 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 | $483.91 |
| Chico, CA | Unavailable | $479.42 |
| El Centro, CA | Unavailable | $479.70 |
| Fresno, CA | Unavailable | $479.42 |
| Hanford, CA | Unavailable | $479.42 |
| Los Angeles, CA | Unavailable | $510.40 |
| Madera, CA | Unavailable | $479.42 |
| Marin County, CA | Unavailable | $559.37 |
| Merced, CA | Unavailable | $479.42 |
| Modesto, CA | Unavailable | $479.42 |
| Napa, CA | Unavailable | $535.51 |
| Oxnard, CA | Unavailable | $505.18 |
| Redding, CA | Unavailable | $479.42 |
| Rest of California | Unavailable | $479.42 |
| Riverside, CA | Unavailable | $497.31 |
| Sacramento, CA | Unavailable | $497.89 |
| Salinas, CA | Unavailable | $495.98 |
| San Benito County, CA | Unavailable | $573.72 |
| San Diego, CA | Unavailable | $504.11 |
| San Francisco, CA | Unavailable | $557.47 |
| San Luis Obispo, CA | Unavailable | $488.72 |
| Santa Clara County, CA | Unavailable | $565.97 |
| Santa Cruz, CA | Unavailable | $506.01 |
| Santa Maria, CA | Unavailable | $496.87 |
| Santa Rosa, CA | Unavailable | $510.70 |
| Stockton, CA | Unavailable | $479.42 |
| Vallejo, CA | Unavailable | $532.78 |
| Visalia, CA | Unavailable | $479.42 |
| Yuba City, CA | Unavailable | $479.42 |
How the 46258 rate is calculated
Each of 46258’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 · 46258
RVUs × geographic indexes × conversion factor
Work6.25
6.25 RVUs× 1.000 GPCI
Practice expense6.48
6.48 RVUs× 1.000 GPCI
Malpractice1.67
1.67 RVUs× 1.000 GPCI
Adjusted RVUs
14.4000
Conversion factor
$33.4009
Medicare rate
$480.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46258
46258 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46258
Hemorrhoidectomy, single group with fistulectomy
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 46258
Hemorrhoidectomy, single group with fistulectomy
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
46258 without 51 · national facility
$480.97
Hemorrhoidectomy, single group with fistulectomy
46258-51 · Second procedure: 50%
$240.49
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%).
46258 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46255HemorrhoidectomyOne internal and external group
- Choose 46255 for excision of one internal and external hemorrhoid group without fistulectomy. The fistulectomy is the distinguishing work in 46258.
- 46257HemorrhoidectomyOne group with fissurectomy
- 46257 combines single-group hemorrhoidectomy with fissurectomy. 46258 combines it with fistulectomy.
- 46262HemorrhoidectomyTwo or more groups, with fistulectomy
- Both include fistulectomy, but 46262 is for removal of two or more internal and external hemorrhoid groups; 46258 is for one.
- 46270Anal fistula surgerySubcutaneous tract
- 46270 covers fistulectomy for a subcutaneous fistula without the combined single-group hemorrhoidectomy reported by 46258.
46258 billing questions
How does this differ from 46255?
46258 includes fistulectomy with removal of one internal and external hemorrhoid group. Use 46255 when that group is removed without fistulectomy.
When is 46257 a better fit?
46257 pairs single-group hemorrhoidectomy with fissurectomy. This code is for the combination with fistulectomy instead.
How many hemorrhoid groups does this code cover?
It describes one internal and external hemorrhoid column or group. When two or more groups are removed with fistulectomy, compare 46262.
What should the operative note support?
Document the single hemorrhoid group excised, the fistula treated, and the operative work performed. The record should make clear that fistulectomy occurred during the same session.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery payment are not permitted for this service.
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
Fee sheets · Coming soon
Put 46258 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist