CPT code 46262: Hemorrhoidectomy, two or more groups, with fistulectomy2026 Medicare rate & RVUs in Guam
Reports excision of internal and external hemorrhoids in two or more groups together with fistulectomy, with fissurectomy included when performed.
CMS doesn’t publish an office rate for 46262 in Guam.
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 46262 covers
A surgeon removes internal and external hemorrhoidal tissue from at least two columns or groups and excises an associated anal fistula. Fissurectomy may also be performed as part of the service. This operation is typically performed by a colorectal or general surgeon in an operating room, commonly in a facility setting.
Select this code when the operative report supports removal of hemorrhoids from two or more groups and fistula excision during the same operation. The note should identify the treated hemorrhoidal groups and describe the fistula work; a hemorrhoid procedure without fistulectomy belongs to a different code. CMS includes the day-before preoperative visit and 90 days of related postoperative care in the global period. 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 multiple procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, 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.
46262 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $594.72 |
How the 46262 rate is calculated
Each of 46262’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 · 46262
RVUs × geographic indexes × conversion factor
Work7.71
7.71 RVUs× 1.000 GPCI
Practice expense7.83
7.83 RVUs× 1.000 GPCI
Malpractice2.06
2.06 RVUs× 1.000 GPCI
Adjusted RVUs
17.6000
Conversion factor
$33.4009
Medicare rate
$587.86
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46262
46262 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46262
Hemorrhoidectomy, two or more groups, 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) | 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 · 46262
Hemorrhoidectomy, two or more groups, 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
46262 without 51 · national facility
$587.86
Hemorrhoidectomy, two or more groups, with fistulectomy
46262-51 · Second procedure: 50%
$293.93
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%).
46262 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46258HemorrhoidectomySingle group with fistulectomy
- Both include fistulectomy with internal and external hemorrhoid removal. Choose 46258 for one group and 46262 for two or more.
- 46260HemorrhoidectomyInternal and external, 2+ groups
- Both cover removal from two or more hemorrhoid groups. Choose 46262 when fistulectomy is also performed; 46260 describes the hemorrhoidectomy without it.
- 46261HemorrhoidectomyMultiple groups with fissurectomy
- Both cover two or more hemorrhoid groups, but 46261 includes fissurectomy while 46262 includes fistulectomy.
46262 billing questions
How does this differ from 46258?
46262 is for hemorrhoidal tissue removed from two or more groups with fistulectomy. Code 46258 is the corresponding fistulectomy service for a single group.
When is 46260 a better choice?
Use 46260 for removal of internal and external hemorrhoids from two or more groups when the operation does not include fistulectomy. Code 46262 includes the fistula excision.
Can fissurectomy be part of this service?
Yes. Fissurectomy may be performed as part of the operation described by 46262; the code also includes fistulectomy.
Should modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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