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CPT code 46604: Anoscopy, with dilation2026 Medicare rate & RVUs in Santa Clara County, CA

Report this service when the clinician examines the anal canal with an anoscope and dilates a narrowed area during the procedure.

CMS RVU26DEffective Oct 1, 2026One payment locality1.1K Medicare services in 2024

In Santa Clara County, CA, Medicare pays $979.14 for 46604 in the office and $72.70 when it’s performed in a hospital or facility.

$979.14Office (non-facility)
$72.70Hospital or facility
+41.7%vs the national office rate ($691.06)

Check a contract rate as a % of Medicare · 46604 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 46604 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Santa Clara County, CA
  2. What 46604 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 46604 covers

A clinician advances an anoscope to inspect the anal canal and dilates a narrowed segment under direct visualization. Dilation may use a balloon, guidewire, or bougie. A typical indication is anal canal narrowing that makes passage difficult or limits examination. Colorectal surgeons and other clinicians who perform anorectal procedures may provide the service in an office or outpatient facility.

Report this code when the documented service includes both anoscopic examination and dilation; a diagnostic examination without dilation is a different service. The note should identify the narrowing and document the dilation performed and its method. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Do not use modifier 50. Medicare does not pay an assistant-at-surgery claim 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.

How Santa Clara County, CA compares for 46604

Across 109 of 109 payment localities, the office rate for 46604 runs from $596.27 in Arkansas to $979.98 in San Benito County, CA. Santa Clara County, CA pays $979.14. The RVUs are the same everywhere; the geographic indexes change the dollars.

46604 in Santa Clara County, CA vs other payment areas
  1. Santa Clara County, CA · this page$979.14
  2. Bakersfield, CA · California$751.91−$227.23
  3. Chico, CA · California$751.40−$227.74
  4. El Centro, CA · California$751.43−$227.71
  5. Fresno, CA · California$751.40−$227.74
  6. Hanford, CA · California$751.40−$227.74
  7. Los Angeles, CA · California$809.67−$169.47

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

Every other payment area

46604 in every other Medicare payment locality
Payment localityOfficeFacility
Madera, CACalifornia$751.40$62.45
Merced, CACalifornia$751.40$62.45
Modesto, CACalifornia$751.40$62.45
Napa, CACalifornia$897.44$68.93
Oxnard, CACalifornia$808.33$65.32
Redding, CACalifornia$751.40$62.45
Rest of CaliforniaCalifornia$751.40$62.45
Riverside, CACalifornia$753.34$64.39

46604 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.

$596.27

$865.69

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

View every state and territory as a table
46604 office rate range by state
State / territoryOffice rate rangeLocalities
AK$747.421
AL$607.001
AR$596.271
AZ$670.001
CA$751.40–$979.9829
CO$731.851
CT$743.171
DC$809.541
DE$682.801
FL$665.42–$726.973
GA$621.84–$702.802
GU$777.811
HI$777.811
IA$632.051
ID$635.761
IL$637.76–$713.534
IN$640.401
KS$625.521
KY$618.221
LA$615.87–$653.432
MA$724.92–$818.192
MD$698.73–$809.543
ME$636.66–$682.982
MI$635.15–$672.382
MN$705.731
MO$600.98–$659.803
MS$598.921
MT$691.051
NC$645.231
ND$687.491
NE$637.151
NH$717.031
NJ$752.94–$797.842
NM$638.191
NV$690.711
NY$656.70–$821.525
OH$634.421
OK$620.001
OR$686.67–$762.392
PA$637.30–$719.542
PR$698.141
RI$712.551
SC$640.641
SD$687.071
TN$628.981
TX$631.99–$728.248
UT$651.351
VA$678.22–$809.542
VI$698.141
VT$681.581
WA$724.60–$839.562
WI$659.531
WV$608.291
WY$689.501

See 46604 in every payment locality

How the 46604 rate is calculated

Each of 46604’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 · 46604

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.00

1.00 RVUs× 1.000 GPCI

Practice expense19.51

19.51 RVUs× 1.000 GPCI

Malpractice0.18

0.18 RVUs× 1.000 GPCI

Adjusted RVUs

20.6900

Conversion factor

$33.4009

Medicare rate

$691.06

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

The exact Santa Clara County, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,600

Code
46604
Physician work
1.00
Practice expense
19.51
Malpractice
0.18

GPCI2026.csv

28

Locality
Santa Clara County, CA
Physician work
1.110
Practice expense
1.442
Malpractice
0.397
Office calculation for 46604 in Santa Clara County, CA
ComponentRVULocality factorAdjusted
Physician work1.00× 1.1101.1100
Practice expense19.51× 1.44228.1334
Malpractice0.18× 0.3970.0715
Total RVUs29.3149
Conversion factor× 33.4009

Office rate, Santa Clara County, CA$979.14

Office: (1 × 1.11 + 19.51 × 1.442 + 0.18 × 0.397) × $33.4009 = $979.14

Facility: (1 × 1.11 + 0.69 × 1.442 + 0.18 × 0.397) × $33.4009 = $72.70

Open 46604 in the RVU calculator

Payment rules and modifiers for 46604

The CMS indicators that decide how 46604 is paid alongside other services.

CMS payment indicators · 46604

Anoscopy, with dilation

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
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

46604 without 51 · national office

$691.06

Anoscopy, with dilation

46604-51 · Second procedure: 50%

$345.53

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 46604

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

Codes related to 46604
CodeHow it relatesOffice range, Santa Clara County, CA
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without dilation.$177.13
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy when tissue sampling, rather than dilation, is performed.$422.67
45910Rectal dilation, under anesthesiaAnal sphincter dilation under anesthesia other than local, without this anoscopy service.No office rate

How 46604 has changed in Santa Clara County, CA

46604 · Office / nonfacility

$979.14

Effective 2026-10-01

The base rate is $145.65 higher than on 2025-10-01, moving from $833.49 to $979.14 (17.5%).

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

    $833.49changed to$979.14

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.03 changed to 1.00
    • Practice expense RVU 17.12 changed to 19.51
    • Malpractice RVU 0.16 changed to 0.18
    • Work GPCI 1.100 changed to 1.110
    • Practice expense GPCI 1.435 changed to 1.442
    • Malpractice GPCI 0.420 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $900.05changed to$833.49

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 18.00 changed to 17.12
    • Malpractice RVU 0.18 changed to 0.16

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $885.36changed to$900.05

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $928.49changed to$885.36

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 18.59 changed to 18.00
    • Work GPCI 1.098 changed to 1.100
    • Practice expense GPCI 1.409 changed to 1.435
    • Malpractice GPCI 0.417 changed to 0.420

  5. January 1, 2023

    RVU23A

    $985.59changed to$928.49

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 19.72 changed to 18.59
    • Malpractice RVU 0.19 changed to 0.18
    • Work GPCI 1.096 changed to 1.098
    • Practice expense GPCI 1.383 changed to 1.409
    • Malpractice GPCI 0.414 changed to 0.417

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1004.91changed to$985.59

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 19.96 changed to 19.72
    • Malpractice RVU 0.16 changed to 0.19

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $922.58changed to$1004.91

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 17.81 changed to 19.96
    • Malpractice RVU 0.15 changed to 0.16
    • Work GPCI 1.089 changed to 1.096
    • Practice expense GPCI 1.369 changed to 1.383
    • Malpractice GPCI 0.401 changed to 0.414

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $877.35changed to$922.58

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 17.11 changed to 17.81
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.083 changed to 1.089
    • Practice expense GPCI 1.354 changed to 1.369
    • Malpractice GPCI 0.388 changed to 0.401

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $854.46changed to$877.35

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 16.66 changed to 17.11

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $840.67changed to$854.46

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 16.46 changed to 16.66
    • Malpractice RVU 0.17 changed to 0.16
    • Work GPCI 1.086 changed to 1.083
    • Practice expense GPCI 1.351 changed to 1.354
    • Malpractice GPCI 0.402 changed to 0.388

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $832.64changed to$840.67

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 16.38 changed to 16.46
    • Work GPCI 1.088 changed to 1.086
    • Practice expense GPCI 1.347 changed to 1.351
    • Malpractice GPCI 0.416 changed to 0.402

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $849.53changed to$832.64

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 16.67 changed to 16.38
    • Malpractice RVU 0.16 changed to 0.17

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $845.30changed to$849.53

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $828.00changed to$845.30

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 16.34 changed to 16.67
    • Malpractice RVU 0.15 changed to 0.16
    • Work GPCI 1.083 changed to 1.088
    • Practice expense GPCI 1.342 changed to 1.347
    • Malpractice GPCI 0.466 changed to 0.416

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $880.73changed to$828.00

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 18.47 changed to 16.34
    • Malpractice RVU 0.16 changed to 0.15
    • Work GPCI 1.077 changed to 1.083
    • Practice expense GPCI 1.337 changed to 1.342
    • Malpractice GPCI 0.516 changed to 0.466

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$880.73

  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$979.14$72.70RVU26D
2026-07-01$979.14$72.70RVU26C
2026-04-01$979.14$72.70RVU26B
2026-01-01$979.14$72.70RVU26A
2025-10-01$833.49$75.49RVU25D
2025-07-01$833.49$75.49RVU25C
2025-04-01$833.49$75.49RVU25B
2025-01-01$833.49$75.49RVU25A
2024-10-01$900.05$77.01RVU24D
2024-07-01$900.05$77.01RVU24C
2024-04-01$900.05$77.01RVU24B
2024-03-09$900.05$77.01RVU24AR
2024-01-01$885.36$75.76RVU24A
2023-10-01$928.49$76.68RVU23D
2023-07-01$928.49$76.68RVU23C
2023-04-01$928.49$76.68RVU23B
2023-01-01$928.49$76.68RVU23A
2022-10-01$985.59$77.21RVU22D
2022-07-01$985.59$77.21RVU22C
2022-04-01$985.59$77.21RVU22B
2022-01-01$985.59$77.21RVU22A
2021-10-01$1,004.91$76.45RVU21D
2021-07-01$1,004.91$76.45RVU21C
2021-04-01$1,004.91$76.45RVU21B
2021-01-01$1,004.91$76.45RVU21A
2020-10-01$922.58$77.73RVU20D
2020-07-01$922.58$77.73RVU20C
2020-04-01$922.58$77.73RVU20B
2020-01-01$922.58$77.73RVU20A
2019-10-01$877.35$77.08RVU19D
2019-07-01$877.35$77.08RVU19C
2019-04-01$877.35$77.08RVU19B
2019-01-01$877.35$77.08RVU19A
2018-10-01$854.46$77.97RVU18D
2018-07-01$854.46$77.97RVU18C
2018-04-01$854.46$77.97RVU18B
2018-01-01$854.46$77.97RVU18AR1
2017-10-01$840.67$77.99RVU17D
2017-07-01$840.67$77.99RVU17C
2017-04-01$840.67$77.99RVU17B
2017-01-01$840.67$77.99RVU17A
2016-10-01$832.64$77.38RVU16D
2016-07-01$832.64$77.38RVU16C
2016-04-01$832.64$77.38RVU16B
2016-01-01$832.64$77.38RVU16A
2015-10-01$849.53$77.99RVU15D
2015-07-01$849.53$77.99RVU15C
2015-04-01$845.30$77.61RVU15B
2015-01-01$845.30$77.61RVU15A
2014-10-01$828.00$77.56RVU14D
2014-07-01$828.00$77.56RVU14C
2014-04-01$828.00$77.56RVU14B
2014-01-01$828.00$77.56RVU14A
2013-10-01$880.73$76.94RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46604 for an earlier date of service

Where the Santa Clara County, CA rate applies

Santa Clara County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 24 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • San Jose
  • Santa Clara
  • Sunnyvale
  • Alum Rock
  • Burbank
  • Cambrian Park
  • Campbell
  • Cupertino

Browse all communities in California

46604 billing questions

When should I report this instead of diagnostic anoscopy?

Report this code when the clinician performs dilation of a narrowed anal canal during anoscopy. A diagnostic examination without dilation points to 46600.

Can I report a biopsy separately when dilation is performed?

This code represents anoscopy with dilation, not biopsy. If the clinician also takes a biopsy, document the additional work and apply the applicable coding and endoscopy family pricing rules.

Should I append modifier 50?

No. Medicare's bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

Is same-day evaluation and management work included?

The code has a 0-day global period, which includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant-at-surgery claim for this service. Co-surgeon and team-surgery billing are not permitted.

What documentation supports reporting dilation?

Document the anal canal narrowing and the dilation actually performed, including the method used. An anoscopic examination alone does not support this code.

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 46604PPRRVU2026_Oct_nonQPP.csv, line 5,600 (RVU26D)
Geographic factors for Santa Clara County, CAGPCI2026.csv, line 28 (RVU26D)

Open CMS sourceHow we calculate rates

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