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CPT code 46606: Anoscopy biopsy, biopsy performed2026 Medicare rate & RVUs in Los Angeles, CA

Report this service when standard anoscopy is used to inspect the anal canal and obtain one or more tissue biopsies for pathologic examination.

CMS RVU26DEffective Oct 1, 2026One payment locality1.8K Medicare services in 2024

In Los Angeles, CA, Medicare pays $354.11 for 46606 in the office and $75.15 when it’s performed in a hospital or facility.

$354.11Office (non-facility)
$75.15Hospital or facility
+15.4%vs the national office rate ($306.95)

Check a contract rate as a % of Medicare · 46606 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 46606 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Los Angeles, CA
  2. What 46606 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 46606 covers

A clinician examines the anal canal through an anoscope and takes one or more tissue samples from an abnormal area for pathologic evaluation. Colorectal surgeons and gastroenterologists commonly perform this service in an office or procedure room when inspection identifies tissue that needs histologic assessment, such as a suspicious mucosal lesion or ulcer. The biopsy distinguishes this service from diagnostic anoscopy without tissue sampling and from procedures that remove or ablate a lesion.

Report the code when the documented service includes tissue biopsy; record the finding and sampling site. Same-day preoperative and postoperative care is included in its 0-day global period. When related endoscopies are performed together, endoscopy family pricing applies, so the procedures are priced under the family rules rather than each being treated as an unrelated service. Modifier 50 is inappropriate for this code. 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.

How Los Angeles, CA compares for 46606

Across 109 of 109 payment localities, the office rate for 46606 runs from $266.89 in Arkansas to $423.60 in San Benito County, CA. Los Angeles, CA pays $354.11. The RVUs are the same everywhere; the geographic indexes change the dollars.

46606 in Los Angeles, CA vs other payment areas
  1. Los Angeles, CA · this page$354.11
  2. Bakersfield, CA · California$330.16−$23.95
  3. Chico, CA · California$329.59−$24.52
  4. El Centro, CA · California$329.63−$24.48
  5. Fresno, CA · California$329.59−$24.52
  6. Hanford, CA · California$329.59−$24.52
  7. Madera, CA · California$329.59−$24.52

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

Every other payment area

46606 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$329.59$71.15
Modesto, CACalifornia$329.59$71.15
Napa, CACalifornia$389.19$78.39
Oxnard, CACalifornia$353.07$74.34
Redding, CACalifornia$329.59$71.15
Rest of CaliforniaCalifornia$329.59$71.15
Riverside, CACalifornia$331.75$73.30
Sacramento, CACalifornia$347.84$73.59

46606 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.

$266.89

$376.60

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

View every state and territory as a table
46606 office rate range by state
State / territoryOffice rate rangeLocalities
AK$340.471
AL$271.411
AR$266.891
AZ$297.901
CA$329.59–$423.6029
CO$322.681
CT$329.251
DC$356.311
DE$303.341
FL$298.82–$327.883
GA$280.03–$312.592
GU$339.931
HI$339.931
IA$280.721
ID$282.541
IL$287.99–$319.444
IN$284.451
KS$278.571
KY$277.391
LA$276.64–$292.452
MA$320.07–$358.492
MD$309.93–$356.313
ME$283.53–$302.142
MI$285.09–$302.402
MN$309.831
MO$270.74–$294.433
MS$268.901
MT$306.941
NC$287.041
ND$302.991
NE$282.691
NH$316.831
NJ$333.20–$351.662
NM$286.621
NV$306.101
NY$291.91–$364.555
OH$284.281
OK$277.521
OR$303.93–$334.862
PA$285.17–$319.662
PR$309.731
RI$315.591
SC$286.101
SD$302.521
TN$280.091
TX$282.97–$321.428
UT$290.601
VA$300.55–$356.312
VI$309.731
VT$301.041
WA$319.71–$366.982
WI$291.361
WV$275.621
WY$305.221

See 46606 in every payment locality

How the 46606 rate is calculated

Each of 46606’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 · 46606

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.17

1.17 RVUs× 1.000 GPCI

Practice expense7.82

7.82 RVUs× 1.000 GPCI

Malpractice0.20

0.20 RVUs× 1.000 GPCI

Adjusted RVUs

9.1900

Conversion factor

$33.4009

Medicare rate

$306.95

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

The exact Los Angeles, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,601

Code
46606
Physician work
1.17
Practice expense
7.82
Malpractice
0.20

GPCI2026.csv

13

Locality
Los Angeles, CA
Physician work
1.041
Practice expense
1.183
Malpractice
0.664
Office calculation for 46606 in Los Angeles, CA
ComponentRVULocality factorAdjusted
Physician work1.17× 1.0411.2180
Practice expense7.82× 1.1839.2511
Malpractice0.20× 0.6640.1328
Total RVUs10.6018
Conversion factor× 33.4009

Office rate, Los Angeles, CA$354.11

Office: (1.17 × 1.041 + 7.82 × 1.183 + 0.2 × 0.664) × $33.4009 = $354.11

Facility: (1.17 × 1.041 + 0.76 × 1.183 + 0.2 × 0.664) × $33.4009 = $75.15

Open 46606 in the RVU calculator

Payment rules and modifiers for 46606

The CMS indicators that decide how 46606 is paid alongside other services.

CMS payment indicators · 46606

Anoscopy biopsy, biopsy performed

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

46606 without 51 · national office

$306.95

Anoscopy biopsy, biopsy performed

46606-51 · Second procedure: 50%

$153.48

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 46606

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

Codes related to 46606
CodeHow it relatesOffice range, Los Angeles, CA
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without tissue biopsy.$148.57
46607Anoscopy, high-resolution exam with biopsyBiopsy performed using high-resolution anoscopy.$257.64
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with lesion removal rather than tissue sampling alone.$352.03
46612Anoscopy, lesion removal by excisionAnoscopy with lesion ablation rather than biopsy alone.$420.17

How 46606 has changed in Los Angeles, CA

46606 · Office / nonfacility

$354.11

Effective 2026-10-01

The base rate is $48.67 higher than on 2025-10-01, moving from $305.44 to $354.11 (15.9%).

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

    $305.44changed to$354.11

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.20 changed to 1.17
    • Practice expense RVU 6.74 changed to 7.82
    • Malpractice RVU 0.21 changed to 0.20
    • Work GPCI 1.042 changed to 1.041
    • Practice expense GPCI 1.194 changed to 1.183
    • Malpractice GPCI 0.690 changed to 0.664

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $324.27changed to$305.44

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.99 changed to 6.74

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $318.97changed to$324.27

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $331.71changed to$318.97

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.08 changed to 6.99
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.045 changed to 1.042
    • Practice expense GPCI 1.185 changed to 1.194
    • Malpractice GPCI 0.724 changed to 0.690

  5. January 1, 2023

    RVU23A

    $344.64changed to$331.71

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.27 changed to 7.08
    • Malpractice RVU 0.21 changed to 0.20
    • Work GPCI 1.048 changed to 1.045
    • Practice expense GPCI 1.175 changed to 1.185
    • Malpractice GPCI 0.757 changed to 0.724

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $342.57changed to$344.64

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.15 changed to 7.27

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $301.57changed to$342.57

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.92 changed to 7.15
    • Malpractice RVU 0.19 changed to 0.21
    • Work GPCI 1.047 changed to 1.048
    • Practice expense GPCI 1.176 changed to 1.175
    • Malpractice GPCI 0.725 changed to 0.757

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $283.11changed to$301.57

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.49 changed to 5.92
    • Malpractice RVU 0.20 changed to 0.19
    • Work GPCI 1.046 changed to 1.047
    • Practice expense GPCI 1.177 changed to 1.176
    • Malpractice GPCI 0.694 changed to 0.725

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $267.55changed to$283.11

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.13 changed to 5.49

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $262.29changed to$267.55

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.04 changed to 5.13
    • Work GPCI 1.047 changed to 1.046
    • Practice expense GPCI 1.169 changed to 1.177
    • Malpractice GPCI 0.801 changed to 0.694

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $260.58changed to$262.29

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.03 changed to 5.04
    • Practice expense GPCI 1.161 changed to 1.169
    • Malpractice GPCI 0.908 changed to 0.801

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $261.61changed to$260.58

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.04 changed to 5.03
    • Malpractice RVU 0.19 changed to 0.20

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $260.31changed to$261.61

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $258.31changed to$260.31

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.00 changed to 5.04
    • Malpractice RVU 0.22 changed to 0.19
    • Work GPCI 1.042 changed to 1.047
    • Practice expense GPCI 1.158 changed to 1.161
    • Malpractice GPCI 0.775 changed to 0.908

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $267.19changed to$258.31

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.60 changed to 5.00
    • Malpractice RVU 0.23 changed to 0.22
    • Work GPCI 1.036 changed to 1.042
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.642 changed to 0.775

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$267.19

  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$354.11$75.15RVU26D
2026-07-01$354.11$75.15RVU26C
2026-04-01$354.11$75.15RVU26B
2026-01-01$354.11$75.15RVU26A
2025-10-01$305.44$78.73RVU25D
2025-07-01$305.44$78.73RVU25C
2025-04-01$305.44$78.73RVU25B
2025-01-01$305.44$78.73RVU25A
2024-10-01$324.27$80.23RVU24D
2024-07-01$324.27$80.23RVU24C
2024-04-01$324.27$80.23RVU24B
2024-03-09$324.27$80.23RVU24AR
2024-01-01$318.97$78.92RVU24A
2023-10-01$331.71$80.73RVU23D
2023-07-01$331.71$80.73RVU23C
2023-04-01$331.71$80.73RVU23B
2023-01-01$331.71$80.73RVU23A
2022-10-01$344.64$81.96RVU22D
2022-07-01$344.64$81.96RVU22C
2022-04-01$344.64$81.96RVU22B
2022-01-01$344.64$81.96RVU22A
2021-10-01$342.57$82.23RVU21D
2021-07-01$342.57$82.23RVU21C
2021-04-01$342.57$82.23RVU21B
2021-01-01$342.57$82.23RVU21A
2020-10-01$301.57$83.42RVU20D
2020-07-01$301.57$83.42RVU20C
2020-04-01$301.57$83.42RVU20B
2020-01-01$301.57$83.42RVU20A
2019-10-01$283.11$82.90RVU19D
2019-07-01$283.11$82.90RVU19C
2019-04-01$283.11$82.90RVU19B
2019-01-01$283.11$82.90RVU19A
2018-10-01$267.55$84.08RVU18D
2018-07-01$267.55$84.08RVU18C
2018-04-01$267.55$84.08RVU18B
2018-01-01$267.55$84.08RVU18AR1
2017-10-01$262.29$84.40RVU17D
2017-07-01$262.29$84.40RVU17C
2017-04-01$262.29$84.40RVU17B
2017-01-01$262.29$84.40RVU17A
2016-10-01$260.58$84.74RVU16D
2016-07-01$260.58$84.74RVU16C
2016-04-01$260.58$84.74RVU16B
2016-01-01$260.58$84.74RVU16A
2015-10-01$261.61$85.14RVU15D
2015-07-01$261.61$85.14RVU15C
2015-04-01$260.31$84.71RVU15B
2015-01-01$260.31$84.71RVU15A
2014-10-01$258.31$84.09RVU14D
2014-07-01$258.31$84.09RVU14C
2014-04-01$258.31$84.09RVU14B
2014-01-01$258.31$84.09RVU14A
2013-10-01$267.19$81.48RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46606 for an earlier date of service

Where the Los Angeles, CA rate applies

Los Angeles, CA is a Medicare payment area, not a city. Our Census mapping connects it to 189 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Anaheim
  • Long Beach
  • Los Angeles
  • Orange
  • Acton
  • Agoura Hills
  • Agua Dulce
  • Alhambra

Browse all communities in California

46606 billing questions

When should this be reported instead of 46600?

Report 46606 when anoscopy includes tissue biopsy. Use 46600 for diagnostic inspection without tissue biopsy.

How does 46606 differ from 46607?

Both include biopsy, but 46607 is for diagnostic anoscopy using high-resolution magnification. Report 46606 for biopsy with standard anoscopy.

Can the biopsy be reported separately from the anoscopy?

The biopsy is part of this anoscopy service; do not report a separate code for the tissue sampling itself.

Should modifier 50 be appended for bilateral findings?

No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

What happens when related endoscopies are performed in the same session?

CMS applies endoscopy family pricing to related endoscopies performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.

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 46606PPRRVU2026_Oct_nonQPP.csv, line 5,601 (RVU26D)
Geographic factors for Los Angeles, CAGPCI2026.csv, line 13 (RVU26D)

Open CMS sourceHow we calculate rates

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