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CPT code 46606: Anoscopy biopsy, biopsy performed2026 Medicare rate & RVUs in Hawaii, Guam, HI

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 Hawaii, Guam, HI, Medicare pays $339.93 for 46606 in the office and $71.81 when it’s performed in a hospital or facility.

$339.93Office (non-facility)
$71.81Hospital or facility
+10.7%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 Hawaii, Guam, HI
  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 Hawaii, Guam, HI 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. Hawaii, Guam, HI pays $339.93. The RVUs are the same everywhere; the geographic indexes change the dollars.

46606 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$339.93
  2. Los Angeles, CA · California$354.11+$14.18
  3. Washington, DC area · District of Columbia$356.31+$16.38
  4. Miami, FL · Florida$327.88−$12.05
  5. Chicago, IL · Illinois$317.18−$22.75
  6. Manhattan, NY · New York$355.68+$15.75
  7. Alaska · Alaska$340.47+$0.54

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

Every other payment area

46606 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$271.41$65.07
ArkansasArkansas$266.89$64.32
ArizonaArizona$297.90$69.40
Bakersfield, CACalifornia$330.16$71.71
Chico, CACalifornia$329.59$71.15
El Centro, CACalifornia$329.63$71.18
Fresno, CACalifornia$329.59$71.15
Hanford, CACalifornia$329.59$71.15

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 Hawaii, Guam, HI 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

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 46606 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.17× 1.0001.1700
Practice expense7.82× 1.1378.8913
Malpractice0.20× 0.5790.1158
Total RVUs10.1771
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$339.93

Office: (1.17 × 1 + 7.82 × 1.137 + 0.2 × 0.579) × $33.4009 = $339.93

Facility: (1.17 × 1 + 0.76 × 1.137 + 0.2 × 0.579) × $33.4009 = $71.81

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, Hawaii, Guam, HI
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without tissue biopsy.$142.63
46607Anoscopy, high-resolution exam with biopsyBiopsy performed using high-resolution anoscopy.$246.99
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with lesion removal rather than tissue sampling alone.$337.86
46612Anoscopy, lesion removal by excisionAnoscopy with lesion ablation rather than biopsy alone.$403.04

How 46606 has changed in Hawaii, Guam, HI

46606 · Office / nonfacility

$339.93

Effective 2026-10-01

The base rate is $46.80 higher than on 2025-10-01, moving from $293.13 to $339.93 (16.0%).

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

    $293.13changed to$339.93

    • 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
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $311.22changed to$293.13

    • 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

    $306.14changed to$311.22

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $319.92changed to$306.14

    • 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 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $334.41changed to$319.92

    • 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 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $332.40changed to$334.41

    • 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

    $292.40changed to$332.40

    • 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 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $274.46changed to$292.40

    • 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 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $259.30changed to$274.46

    • 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

    $256.31changed to$259.30

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.04 changed to 5.13
    • Work GPCI 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $256.79changed to$256.31

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.03 changed to 5.04
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $257.91changed to$256.79

    • 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

    $256.63changed to$257.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $255.68changed to$256.63

    • 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 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $266.18changed to$255.68

    • 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 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$266.18

  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$339.93$71.81RVU26D
2026-07-01$339.93$71.81RVU26C
2026-04-01$339.93$71.81RVU26B
2026-01-01$339.93$71.81RVU26A
2025-10-01$293.13$74.96RVU25D
2025-07-01$293.13$74.96RVU25C
2025-04-01$293.13$74.96RVU25B
2025-01-01$293.13$74.96RVU25A
2024-10-01$311.22$76.38RVU24D
2024-07-01$311.22$76.38RVU24C
2024-04-01$311.22$76.38RVU24B
2024-03-09$311.22$76.38RVU24AR
2024-01-01$306.14$75.13RVU24A
2023-10-01$319.92$77.21RVU23D
2023-07-01$319.92$77.21RVU23C
2023-04-01$319.92$77.21RVU23B
2023-01-01$319.92$77.21RVU23A
2022-10-01$334.41$78.89RVU22D
2022-07-01$334.41$78.89RVU22C
2022-04-01$334.41$78.89RVU22B
2022-01-01$334.41$78.89RVU22A
2021-10-01$332.40$79.14RVU21D
2021-07-01$332.40$79.14RVU21C
2021-04-01$332.40$79.14RVU21B
2021-01-01$332.40$79.14RVU21A
2020-10-01$292.40$80.19RVU20D
2020-07-01$292.40$80.19RVU20C
2020-04-01$292.40$80.19RVU20B
2020-01-01$292.40$80.19RVU20A
2019-10-01$274.46$79.52RVU19D
2019-07-01$274.46$79.52RVU19C
2019-04-01$274.46$79.52RVU19B
2019-01-01$274.46$79.52RVU19A
2018-10-01$259.30$80.67RVU18D
2018-07-01$259.30$80.67RVU18C
2018-04-01$259.30$80.67RVU18B
2018-01-01$259.30$80.67RVU18AR1
2017-10-01$256.31$80.71RVU17D
2017-07-01$256.31$80.71RVU17C
2017-04-01$256.31$80.71RVU17B
2017-01-01$256.31$80.71RVU17A
2016-10-01$256.79$80.80RVU16D
2016-07-01$256.79$80.80RVU16C
2016-04-01$256.79$80.80RVU16B
2016-01-01$256.79$80.80RVU16A
2015-10-01$257.91$81.29RVU15D
2015-07-01$257.91$81.29RVU15C
2015-04-01$256.63$80.89RVU15B
2015-01-01$256.63$80.89RVU15A
2014-10-01$255.68$81.45RVU14D
2014-07-01$255.68$81.45RVU14C
2014-04-01$255.68$81.45RVU14B
2014-01-01$255.68$81.45RVU14A
2013-10-01$266.18$80.46RVU13D
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 Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

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 Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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