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CPT code 46260: Hemorrhoidectomy, internal and external, 2+ groups2026 Medicare rate & RVUs

Reports surgical removal of internal and external hemorrhoids involving two or more groups, when both tissue types are treated during the procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities7.6K Medicare services in 2024

Medicare pays $479.64 for 46260 nationally in a facility.

Medicare rate · 46260

Hemorrhoidectomy, internal and external, 2+ groups

Office or facility?

Work RVUs
6.56
Total RVUs
14.36
Global days
090

National rate · 2026

$479.64

Facility setting, before claim adjustments.

See every locality for 46260 →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 46260 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 46260 covers

This code describes operative removal of hemorrhoidal tissue involving both the internal and external components in at least two groups. It is typically performed by a colorectal or general surgeon, often in an operating room, for symptomatic hemorrhoids selected for surgical treatment. The operative report should make clear that both internal and external hemorrhoidal tissue were removed and document the number of groups treated.

Choose this code based on the tissue treated and the number of groups, not simply the number of individual hemorrhoids. 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% multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; co-surgeons and team surgery 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 46260 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

46260 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$433.24
AlaskaUnavailable$583.12
ArizonaUnavailable$466.50
ArkansasUnavailable$427.51
Atlanta, GAUnavailable$492.74
Austin, TXUnavailable$487.49
Bakersfield, CAUnavailable$487.01
Baltimore area, MDUnavailable$509.50
Beaumont, TXUnavailable$457.04
Brazoria, TXUnavailable$469.60

46260 rates by state

Office rate range in each state. Select a state to see its payment localities.

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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
46260 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 46260 rate is calculated

Each of 46260’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 · 46260

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.56

6.56 RVUs× 1.000 GPCI

Practice expense6.46

6.46 RVUs× 1.000 GPCI

Malpractice1.34

1.34 RVUs× 1.000 GPCI

Adjusted RVUs

14.3600

Conversion factor

$33.4009

Medicare rate

$479.64

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

Payment rules and modifiers for 46260

46260 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46260

Hemorrhoidectomy, internal and external, 2+ 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 · 46260

Hemorrhoidectomy, internal and external, 2+ 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

46260 without 51 · national facility

$479.64

Hemorrhoidectomy, internal and external, 2+ groups

46260-51 · Second procedure: 50%

$239.82

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

46260 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 46260

    Hemorrhoidectomy, internal and external, 2+ groups6.56 wRVU

    Not priced

  • 46250

    Hemorrhoidectomy, external, two or more groups4.14 wRVU

    $536.75

  • 46255

    Hemorrhoidectomy, one internal and external group4.84 wRVU

    $580.84

  • 46261

    Hemorrhoidectomy, multiple groups with fissurectomy7.57 wRVU

    Not priced

  • 46221

    Hemorrhoid ligation, rubber-band technique2.3 wRVU

    $325.66

How to choose

46250HemorrhoidectomyExternal, two or more groups
Use 46250 when the operation removes external hemorrhoidal groups only. Use 46260 when both internal and external tissue are removed from two or more groups.
46255HemorrhoidectomyOne internal and external group
Both codes cover internal and external hemorrhoidal tissue, but 46255 is for one group; 46260 is for two or more.
46261HemorrhoidectomyMultiple groups with fissurectomy
46261 includes a fissurectomy with removal of internal and external hemorrhoids from two or more groups. Without that accompanying fissurectomy, the multiple-group procedure is 46260.
46221Hemorrhoid ligationRubber-band technique
46221 reports ligation of hemorrhoids rather than excisional removal. Select according to the treatment actually performed.

Codes related to 46260

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

Codes related to 46260
CodeHow it relatesNational office range
Same family
46250Hemorrhoidectomy, external, two or more groupsRemoval of multiple external groups without the internal-and-external treatment described here.$470.92–$702.67
46255Hemorrhoidectomy, one internal and external groupRemoval of internal and external hemorrhoidal tissue from one group.$511.28–$756.36
46261Hemorrhoidectomy, multiple groups with fissurectomyMultiple internal and external groups treated with an accompanying fissurectomy.No office rate
46262Hemorrhoidectomy, two or more groups, with fistulectomyMultiple internal and external groups treated with an accompanying fistulectomy.No office rate
Used instead
46221Hemorrhoid ligation, rubber-band techniqueHemorrhoid ligation is a different treatment approach from excisional removal.$286.44–$433.20

46260 billing questions

How does this differ from code 46255?

Code 46255 applies when both internal and external hemorrhoidal tissue are removed from one group. Use 46260 when two or more groups are treated.

When should 46250 be considered instead?

Code 46250 describes removal of external hemorrhoidal groups only. This code requires removal of both internal and external hemorrhoidal tissue.

What documentation supports reporting 46260?

The operative report should identify removal of internal and external hemorrhoidal tissue and document treatment of at least two groups. Record any associated fissure or fistula procedure when performed.

Can modifier 50 be used when hemorrhoids are on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

How are other procedures in the same session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.

Can an assistant or co-surgeon be reported?

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 46260PPRRVU2026_Oct_nonQPP.csv, line 5,587 (RVU26D)

Open CMS sourceHow we calculate rates

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