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CPT code 46604: Anoscopy, with dilation2026 Medicare rate & RVUs in North Carolina

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 North Carolina, Medicare pays $645.23 for 46604 in the office and $58.75 when it’s performed in a hospital or facility.

$645.23Office (non-facility)
$58.75Hospital or facility
−6.6%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 North Carolina
  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 North Carolina 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. North Carolina pays $645.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

46604 in North Carolina vs other payment areas
  1. North Carolina · this page$645.23
  2. Los Angeles, CA · California$809.67+$164.44
  3. Washington, DC area · District of Columbia$809.54+$164.31
  4. Miami, FL · Florida$726.97+$81.74
  5. Chicago, IL · Illinois$702.34+$57.11
  6. Manhattan, NY · New York$802.29+$157.06
  7. Alaska · Alaska$747.42+$102.19

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

Every other payment area

46604 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$607.00$56.97
ArkansasArkansas$596.27$56.29
ArizonaArizona$670.00$60.88
Bakersfield, CACalifornia$751.91$62.96
Chico, CACalifornia$751.40$62.45
El Centro, CACalifornia$751.43$62.48
Fresno, CACalifornia$751.40$62.45
Hanford, CACalifornia$751.40$62.45

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 North Carolina 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

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 46604 in North Carolina
ComponentRVULocality factorAdjusted
Physician work1.00× 1.0001.0000
Practice expense19.51× 0.93318.2028
Malpractice0.18× 0.6390.1150
Total RVUs19.3179
Conversion factor× 33.4009

Office rate, North Carolina$645.23

Office: (1 × 1 + 19.51 × 0.933 + 0.18 × 0.639) × $33.4009 = $645.23

Facility: (1 × 1 + 0.69 × 0.933 + 0.18 × 0.639) × $33.4009 = $58.75

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, North Carolina
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without dilation.$120.71
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy when tissue sampling, rather than dilation, is performed.$287.04
45910Rectal dilation, under anesthesiaAnal sphincter dilation under anesthesia other than local, without this anoscopy service.No office rate

How 46604 has changed in North Carolina

46604 · Office / nonfacility

$645.23

Effective 2026-10-01

The base rate is $95.68 higher than on 2025-10-01, moving from $549.55 to $645.23 (17.4%).

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

    $549.55changed to$645.23

    • 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
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $593.11changed to$549.55

    • 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

    $583.43changed to$593.11

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $623.41changed to$583.43

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 18.59 changed to 18.00
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $674.33changed to$623.41

    • 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
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $686.83changed to$674.33

    • 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

    $639.03changed to$686.83

    • 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
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $615.21changed to$639.03

    • 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
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $599.45changed to$615.21

    • 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

    $591.40changed to$599.45

    • 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
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $586.97changed to$591.40

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 16.38 changed to 16.46
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $598.51changed to$586.97

    • 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

    $595.53changed to$598.51

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $584.62changed to$595.53

    • 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
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $621.36changed to$584.62

    • 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
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $621.36

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$645.23$58.75RVU26D
2026-07-01$645.23$58.75RVU26C
2026-04-01$645.23$58.75RVU26B
2026-01-01$645.23$58.75RVU26A
2025-10-01$549.55$60.42RVU25D
2025-07-01$549.55$60.42RVU25C
2025-04-01$549.55$60.42RVU25B
2025-01-01$549.55$60.42RVU25A
2024-10-01$593.11$62.01RVU24D
2024-07-01$593.11$62.01RVU24C
2024-04-01$593.11$62.01RVU24B
2024-03-09$593.11$62.01RVU24AR
2024-01-01$583.43$60.99RVU24A
2023-10-01$623.41$62.99RVU23D
2023-07-01$623.41$62.99RVU23C
2023-04-01$623.41$62.99RVU23B
2023-01-01$623.41$62.99RVU23A
2022-10-01$674.33$64.79RVU22D
2022-07-01$674.33$64.79RVU22C
2022-04-01$674.33$64.79RVU22B
2022-01-01$674.33$64.79RVU22A
2021-10-01$686.83$63.83RVU21D
2021-07-01$686.83$63.83RVU21C
2021-04-01$686.83$63.83RVU21B
2021-01-01$686.83$63.83RVU21A
2020-10-01$639.03$65.10RVU20D
2020-07-01$639.03$65.10RVU20C
2020-04-01$639.03$65.10RVU20B
2020-01-01$639.03$65.10RVU20A
2019-10-01$615.21$64.95RVU19D
2019-07-01$615.21$64.95RVU19C
2019-04-01$615.21$64.95RVU19B
2019-01-01$615.21$64.95RVU19A
2018-10-01$599.45$65.55RVU18D
2018-07-01$599.45$65.55RVU18C
2018-04-01$599.45$65.55RVU18B
2018-01-01$599.45$65.55RVU18AR1
2017-10-01$591.40$65.82RVU17D
2017-07-01$591.40$65.82RVU17C
2017-04-01$591.40$65.82RVU17B
2017-01-01$591.40$65.82RVU17A
2016-10-01$586.97$65.53RVU16D
2016-07-01$586.97$65.53RVU16C
2016-04-01$586.97$65.53RVU16B
2016-01-01$586.97$65.53RVU16A
2015-10-01$598.51$65.82RVU15D
2015-07-01$598.51$65.82RVU15C
2015-04-01$595.53$65.49RVU15B
2015-01-01$595.53$65.49RVU15A
2014-10-01$584.62$65.12RVU14D
2014-07-01$584.62$65.12RVU14C
2014-04-01$584.62$65.12RVU14B
2014-01-01$584.62$65.12RVU14A
2013-10-01$621.36$64.06RVU13D
2013-07-01$621.36$64.06RVU13C
2013-04-01$621.36$64.06RVU13B
2013-01-01$621.36$64.06RVU13AR

Price 46604 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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 North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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