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CPT code 46600: Diagnostic anoscopy, standard visualization, optional washing2026 Medicare rate & RVUs in Nevada

A clinician examines the anal canal with an anoscope for diagnostic purposes, optionally collecting cells or secretions by brushing or washing.

CMS RVU26DEffective Oct 1, 2026One payment locality94.3K Medicare services in 2024

In Nevada, Medicare pays $128.59 for 46600 in the office and $39.99 when it’s performed in a hospital or facility.

$128.59Office (non-facility)
$39.99Hospital or facility
−0.3%vs the national office rate ($128.93)

Check a contract rate as a % of Medicare · 46600 nationwide

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

We’ll open 46600 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Nevada
  2. What 46600 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 46600 covers

A clinician inserts a short anoscope to inspect the anal canal and nearby distal rectum. Colorectal surgeons, gastroenterologists, and other clinicians may perform the exam in an office or outpatient setting to evaluate symptoms such as anal pain or bleeding, or findings such as suspected hemorrhoids, fissures, or an anal canal lesion. Collection of a specimen by brushing or washing can be part of this diagnostic service.

Report 46600 when the anoscopy is diagnostic and does not include a separately defined service such as biopsy, dilation, or lesion removal. Document the indication, examination findings, and any brushing or washing performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral adjustment is inappropriate; assistant-at-surgery payment is restricted, and 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.

How Nevada compares for 46600

Across 109 of 109 payment localities, the office rate for 46600 runs from $112.37 in Arkansas to $177.50 in San Benito County, CA. Nevada pays $128.59. The RVUs are the same everywhere; the geographic indexes change the dollars.

46600 in Nevada vs other payment areas
  1. Nevada · this page$128.59
  2. Los Angeles, CA · California$148.57+$19.98
  3. Washington, DC area · District of Columbia$149.47+$20.88
  4. Miami, FL · Florida$137.45+$8.86
  5. Chicago, IL · Illinois$133.06+$4.47
  6. Manhattan, NY · New York$149.18+$20.59
  7. Alaska · Alaska$143.78+$15.19

Other areas in Nevada first, then benchmark localities. Bars start at $0.

Every other payment area

46600 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$114.24$36.79
ArkansasArkansas$112.37$36.34
ArizonaArizona$125.19$39.42
Bakersfield, CACalifornia$138.61$41.60
Chico, CACalifornia$138.38$41.37
El Centro, CACalifornia$138.40$41.39
Fresno, CACalifornia$138.38$41.37
Hanford, CACalifornia$138.38$41.37

46600 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.

$112.37

$157.94

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
46600 office rate range by state
State / territoryOffice rate rangeLocalities
AK$143.781
AL$114.241
AR$112.371
AZ$125.191
CA$138.38–$177.5029
CO$135.481
CT$138.181
DC$149.471
DE$127.451
FL$125.51–$137.453
GA$117.75–$131.252
GU$142.631
HI$142.631
IA$118.121
ID$118.861
IL$121.02–$134.044
IN$119.651
KS$117.211
KY$116.691
LA$116.37–$122.912
MA$134.41–$150.372
MD$130.19–$149.473
ME$119.26–$126.972
MI$119.86–$126.972
MN$130.181
MO$113.92–$123.743
MS$113.191
MT$128.921
NC$120.711
ND$127.341
NE$118.931
NH$133.031
NJ$139.86–$147.562
NM$120.481
NV$128.591
NY$122.72–$152.835
OH$119.531
OK$116.751
OR$127.70–$140.542
PA$119.91–$134.202
PR$130.081
RI$132.551
SC$120.301
SD$127.151
TN$117.841
TX$119.00–$134.948
UT$122.161
VA$126.30–$149.472
VI$130.081
VT$126.531
WA$134.26–$153.912
WI$122.531
WV$115.901
WY$128.231

See 46600 in every payment locality

How the 46600 rate is calculated

Each of 46600’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 · 46600

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.54

0.54 RVUs× 1.000 GPCI

Practice expense3.24

3.24 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

3.8600

Conversion factor

$33.4009

Medicare rate

$128.93

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

The exact Nevada inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,598

Code
46600
Physician work
0.54
Practice expense
3.24
Malpractice
0.08

GPCI2026.csv

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 46600 in Nevada
ComponentRVULocality factorAdjusted
Physician work0.54× 1.0000.5400
Practice expense3.24× 1.0013.2432
Malpractice0.08× 0.8330.0666
Total RVUs3.8499
Conversion factor× 33.4009

Office rate, Nevada$128.59

Office: (0.54 × 1 + 3.24 × 1.001 + 0.08 × 0.833) × $33.4009 = $128.59

Facility: (0.54 × 1 + 0.59 × 1.001 + 0.08 × 0.833) × $33.4009 = $39.99

Open 46600 in the RVU calculator

Payment rules and modifiers for 46600

The CMS indicators that decide how 46600 is paid alongside other services.

CMS payment indicators · 46600

Diagnostic anoscopy, standard visualization, optional washing

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46600 without 51 · national office

$128.93

Diagnostic anoscopy, standard visualization, optional washing

46600-51 · Second procedure: 50%

$64.47

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

Codes related to 46600

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

Codes related to 46600
CodeHow it relatesOffice range, Nevada
Same family
46601Anoscopy, high-resolution, without biopsyDiagnostic anoscopy using high-resolution magnification.$164.94
46604Anoscopy, with dilationAnoscopy that includes dilation rather than diagnostic inspection alone.$690.71
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy, without the high-resolution magnification distinction.$306.10
46607Anoscopy, high-resolution exam with biopsyHigh-resolution diagnostic anoscopy that also includes biopsy.$229.28

How 46600 has changed in Nevada

46600 · Office / nonfacility

$128.59

Effective 2026-10-01

The base rate is $18.05 higher than on 2025-10-01, moving from $110.54 to $128.59 (16.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $110.54changed to$128.59

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 0.55 changed to 0.54
    • Practice expense RVU 2.80 changed to 3.24
    • Practice expense GPCI 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $117.37changed to$110.54

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.90 changed to 2.80
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $115.45changed to$117.37

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $122.33changed to$115.45

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.95 changed to 2.90
    • Malpractice RVU 0.10 changed to 0.09
    • Malpractice GPCI 1.098 changed to 0.844

  5. January 1, 2023

    RVU23A

    $127.85changed to$122.33

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.02 changed to 2.95
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $125.77changed to$127.85

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.93 changed to 3.02

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $106.61changed to$125.77

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.30 changed to 2.93
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $99.05changed to$106.61

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.08 changed to 2.30
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $92.71changed to$99.05

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.91 changed to 2.08

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $92.64changed to$92.71

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.88 changed to 1.91
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $93.70changed to$92.64

    • Conversion factor 35.8043 changed to 35.8887
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $94.09changed to$93.70

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.90 changed to 1.88
    • Malpractice RVU 0.07 changed to 0.09

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $93.62changed to$94.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $93.57changed to$93.62

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.87 changed to 1.90
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $97.66changed to$93.57

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.10 changed to 1.87
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$97.66

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$128.59$39.99RVU26D
2026-07-01$128.59$39.99RVU26C
2026-04-01$128.59$39.99RVU26B
2026-01-01$128.59$39.99RVU26A
2025-10-01$110.54$40.03RVU25D
2025-07-01$110.54$40.03RVU25C
2025-04-01$110.54$40.03RVU25B
2025-01-01$110.54$40.03RVU25A
2024-10-01$117.37$40.81RVU24D
2024-07-01$117.37$40.81RVU24C
2024-04-01$117.37$40.81RVU24B
2024-03-09$117.37$40.81RVU24AR
2024-01-01$115.45$40.14RVU24A
2023-10-01$122.33$42.01RVU23D
2023-07-01$122.33$42.01RVU23C
2023-04-01$122.33$42.01RVU23B
2023-01-01$122.33$42.01RVU23A
2022-10-01$127.85$42.72RVU22D
2022-07-01$127.85$42.72RVU22C
2022-04-01$127.85$42.72RVU22B
2022-01-01$127.85$42.72RVU22A
2021-10-01$125.77$42.37RVU21D
2021-07-01$125.77$42.37RVU21C
2021-04-01$125.77$42.37RVU21B
2021-01-01$125.77$42.37RVU21A
2020-10-01$106.61$42.73RVU20D
2020-07-01$106.61$42.73RVU20C
2020-04-01$106.61$42.73RVU20B
2020-01-01$106.61$42.73RVU20A
2019-10-01$99.05$42.60RVU19D
2019-07-01$99.05$42.60RVU19C
2019-04-01$99.05$42.60RVU19B
2019-01-01$99.05$42.60RVU19A
2018-10-01$92.71$42.92RVU18D
2018-07-01$92.71$42.92RVU18C
2018-04-01$92.71$42.92RVU18B
2018-01-01$92.71$42.92RVU18AR1
2017-10-01$92.64$42.91RVU17D
2017-07-01$92.64$42.91RVU17C
2017-04-01$92.64$42.91RVU17B
2017-01-01$92.64$42.91RVU17A
2016-10-01$93.70$43.28RVU16D
2016-07-01$93.70$43.28RVU16C
2016-04-01$93.70$43.28RVU16B
2016-01-01$93.70$43.28RVU16A
2015-10-01$94.09$43.10RVU15D
2015-07-01$94.09$43.10RVU15C
2015-04-01$93.62$42.89RVU15B
2015-01-01$93.62$42.89RVU15A
2014-10-01$93.57$43.30RVU14D
2014-07-01$93.57$43.30RVU14C
2014-04-01$93.57$43.30RVU14B
2014-01-01$93.57$43.30RVU14A
2013-10-01$97.66$43.66RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46600 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

46600 billing questions

When should 46600 be used instead of 46601?

Use 46600 for standard diagnostic anoscopy. Use 46601 when the examination uses high-resolution magnification.

Can brushing or washing be reported separately?

No. Specimen collection by brushing or washing is included in the diagnostic anoscopy service.

Which code applies if the clinician takes a biopsy?

Use 46606 for anoscopy with biopsy without high-resolution magnification, or 46607 when high-resolution magnification and biopsy are performed.

Does 46600 have a postoperative global period?

It has a 0-day global period. Same-day preoperative and postoperative care is included.

How does the multiple-procedure rule affect 46600?

For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.

Can 46600 be billed with bilateral or surgical-team modifiers?

Bilateral adjustment is inappropriate for this code. Assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment 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 46600PPRRVU2026_Oct_nonQPP.csv, line 5,598 (RVU26D)
Geographic factors for NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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