CPT code 46606: Anoscopy biopsy, biopsy performed2026 Medicare rate & RVUs in Montana
Report this service when standard anoscopy is used to inspect the anal canal and obtain one or more tissue biopsies for pathologic examination.
In Montana, Medicare pays $306.94 for 46606 in the office and $71.13 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Montana 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. Montana pays $306.94. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$306.94
- Los Angeles, CA · California$354.11+$47.17
- Washington, DC area · District of Columbia$356.31+$49.37
- Miami, FL · Florida$327.88+$20.94
- Chicago, IL · Illinois$317.18+$10.24
- Manhattan, NY · New York$355.68+$48.74
- Alaska · Alaska$340.47+$33.53
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $329.59 | $71.15 |
| 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 |
| Salinas, CACalifornia | $346.60 | $73.29 |
| San Diego, CACalifornia | $356.26 | $74.23 |
| Marin County, CACalifornia | $414.14 | $81.65 |
| San Francisco, CACalifornia | $413.92 | $81.42 |
| San Benito County, CACalifornia | $423.60 | $83.56 |
| Santa Clara County, CACalifornia | $422.67 | $82.63 |
| San Luis Obispo, CACalifornia | $340.83 | $72.24 |
| Santa Cruz, CACalifornia | $360.83 | $74.32 |
| Santa Maria, CACalifornia | $348.31 | $73.35 |
| Santa Rosa, CACalifornia | $364.58 | $75.00 |
| Stockton, CACalifornia | $329.59 | $71.15 |
| Vallejo, CACalifornia | $388.86 | $78.06 |
| Visalia, CACalifornia | $329.59 | $71.15 |
| Yuba City, CACalifornia | $329.59 | $71.15 |
| ColoradoColorado | $322.68 | $71.77 |
| ConnecticutConnecticut | $329.25 | $75.28 |
| DelawareDelaware | $303.34 | $70.36 |
| Fort Lauderdale, FLFlorida | $315.75 | $76.87 |
| Rest of FloridaFlorida | $298.82 | $73.39 |
| Atlanta, GAGeorgia | $312.59 | $73.01 |
| Rest of GeorgiaGeorgia | $280.03 | $69.68 |
| Hawaii, Guam, HIHawaii | $339.93 | $71.81 |
| IowaIowa | $280.72 | $64.96 |
| IdahoIdaho | $282.54 | $65.59 |
| East St. Louis, ILIllinois | $292.83 | $75.89 |
| Rest of IllinoisIllinois | $287.99 | $72.70 |
| Suburban Chicago, ILIllinois | $319.44 | $77.26 |
| IndianaIndiana | $284.45 | $65.86 |
| KansasKansas | $278.57 | $65.39 |
| KentuckyKentucky | $277.39 | $67.76 |
| New Orleans, LALouisiana | $292.45 | $70.55 |
| Rest of LouisianaLouisiana | $276.64 | $67.94 |
| Metropolitan Boston, MAMassachusetts | $358.49 | $76.94 |
| Rest of MassachusettsMassachusetts | $320.07 | $71.76 |
| Baltimore area, MDMaryland | $328.23 | $75.21 |
| Rest of MarylandMaryland | $309.93 | $71.29 |
| Rest of MaineMaine | $283.53 | $66.59 |
| Southern Maine, MEMaine | $302.14 | $68.45 |
| Detroit, MIMichigan | $302.40 | $74.84 |
| Rest of MichiganMichigan | $285.09 | $69.80 |
| MinnesotaMinnesota | $309.83 | $67.18 |
| Metropolitan Kansas City, MOMissouri | $290.87 | $69.44 |
| Metropolitan St. Louis, MOMissouri | $294.43 | $69.94 |
| Rest of MissouriMissouri | $270.74 | $67.47 |
| MississippiMississippi | $268.90 | $65.87 |
| North CarolinaNorth Carolina | $287.04 | $67.03 |
| North DakotaNorth Dakota | $302.99 | $67.18 |
| NebraskaNebraska | $282.69 | $65.03 |
| New HampshireNew Hampshire | $316.83 | $71.35 |
| Northern New JerseyNew Jersey | $351.66 | $78.12 |
| Rest of New JerseyNew Jersey | $333.20 | $75.69 |
| New MexicoNew Mexico | $286.62 | $70.38 |
| NevadaNevada | $306.10 | $70.05 |
| NYC suburbs and Long Island, NYNew York | $364.55 | $84.17 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $334.93 | $76.72 |
| Queens, NYNew York | $359.95 | $81.22 |
| Rest of New YorkNew York | $291.91 | $67.89 |
| OhioOhio | $284.28 | $68.99 |
| OklahomaOklahoma | $277.52 | $66.94 |
| Portland, OROregon | $334.86 | $72.88 |
| Rest of OregonOregon | $303.93 | $69.06 |
| Metropolitan Philadelphia, PAPennsylvania | $319.66 | $74.18 |
| Rest of PennsylvaniaPennsylvania | $285.17 | $68.69 |
| Puerto RicoPuerto Rico | $309.73 | $71.32 |
| Rhode IslandRhode Island | $315.59 | $72.00 |
| South CarolinaSouth Carolina | $286.10 | $68.21 |
| South DakotaSouth Dakota | $302.52 | $66.71 |
| TennesseeTennessee | $280.09 | $65.74 |
| Austin, TXTexas | $321.42 | $71.93 |
| Beaumont, TXTexas | $282.97 | $68.39 |
| Brazoria, TXTexas | $303.45 | $69.76 |
| Dallas, TXTexas | $305.31 | $70.45 |
| Fort Worth, TXTexas | $302.79 | $70.28 |
| Galveston, TXTexas | $304.29 | $70.13 |
| Houston, TXTexas | $307.95 | $73.79 |
| Rest of TexasTexas | $292.99 | $69.20 |
| UtahUtah | $290.60 | $68.94 |
| VirginiaVirginia | $300.55 | $68.75 |
| Virgin Islands, VIUnited States Virgin Islands | $309.73 | $71.32 |
| VermontVermont | $301.04 | $67.59 |
| Rest of WashingtonWashington | $319.71 | $71.40 |
| King County, WAWashington | $366.98 | $77.64 |
| WisconsinWisconsin | $291.36 | $65.46 |
| West VirginiaWest Virginia | $275.62 | $70.70 |
| WyomingWyoming | $305.22 | $69.41 |
46606 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $340.47 | 1 |
| AL | $271.41 | 1 |
| AR | $266.89 | 1 |
| AZ | $297.90 | 1 |
| CA | $329.59–$423.60 | 29 |
| CO | $322.68 | 1 |
| CT | $329.25 | 1 |
| DC | $356.31 | 1 |
| DE | $303.34 | 1 |
| FL | $298.82–$327.88 | 3 |
| GA | $280.03–$312.59 | 2 |
| GU | $339.93 | 1 |
| HI | $339.93 | 1 |
| IA | $280.72 | 1 |
| ID | $282.54 | 1 |
| IL | $287.99–$319.44 | 4 |
| IN | $284.45 | 1 |
| KS | $278.57 | 1 |
| KY | $277.39 | 1 |
| LA | $276.64–$292.45 | 2 |
| MA | $320.07–$358.49 | 2 |
| MD | $309.93–$356.31 | 3 |
| ME | $283.53–$302.14 | 2 |
| MI | $285.09–$302.40 | 2 |
| MN | $309.83 | 1 |
| MO | $270.74–$294.43 | 3 |
| MS | $268.90 | 1 |
| MT | $306.94 | 1 |
| NC | $287.04 | 1 |
| ND | $302.99 | 1 |
| NE | $282.69 | 1 |
| NH | $316.83 | 1 |
| NJ | $333.20–$351.66 | 2 |
| NM | $286.62 | 1 |
| NV | $306.10 | 1 |
| NY | $291.91–$364.55 | 5 |
| OH | $284.28 | 1 |
| OK | $277.52 | 1 |
| OR | $303.93–$334.86 | 2 |
| PA | $285.17–$319.66 | 2 |
| PR | $309.73 | 1 |
| RI | $315.59 | 1 |
| SC | $286.10 | 1 |
| SD | $302.52 | 1 |
| TN | $280.09 | 1 |
| TX | $282.97–$321.42 | 8 |
| UT | $290.60 | 1 |
| VA | $300.55–$356.31 | 2 |
| VI | $309.73 | 1 |
| VT | $301.04 | 1 |
| WA | $319.71–$366.98 | 2 |
| WI | $291.36 | 1 |
| WV | $275.62 | 1 |
| WY | $305.22 | 1 |
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
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 Montana 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
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.17 | × 1.000 | 1.1700 |
| Practice expense | 7.82 | × 1.000 | 7.8200 |
| Malpractice | 0.20 | × 0.998 | 0.1996 |
| Total RVUs | 9.1896 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$306.94
Office: (1.17 × 1 + 7.82 × 1 + 0.2 × 0.998) × $33.4009 = $306.94
Facility: (1.17 × 1 + 0.76 × 1 + 0.2 × 0.998) × $33.4009 = $71.13
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
How 46606 has changed in Montana
46606 · Office / nonfacility
$306.94
Effective 2026-10-01
The base rate is $43.47 higher than on 2025-10-01, moving from $263.47 to $306.94 (16.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$263.47changed to$306.94
- 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
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$279.46changed to$263.47
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.99 changed to 6.74
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$274.90changed to$279.46
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$287.21changed to$274.90
- 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
January 1, 2023
RVU23A
$300.21changed to$287.21
- 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
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$298.52changed to$300.21
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 7.15 changed to 7.27
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$265.90changed to$298.52
- 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
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$252.86changed to$265.90
- 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
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$239.62changed to$252.86
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.13 changed to 5.49
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$234.20changed to$239.62
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 5.04 changed to 5.13
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$231.84changed to$234.20
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 5.03 changed to 5.04
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$232.60changed to$231.84
- 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.
July 1, 2015
RVU15C
$231.44changed to$232.60
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$231.28changed to$231.44
- 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
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$239.99changed to$231.28
- 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
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $239.99
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $306.94 | $71.13 | RVU26D |
| 2026-07-01 | $306.94 | $71.13 | RVU26C |
| 2026-04-01 | $306.94 | $71.13 | RVU26B |
| 2026-01-01 | $306.94 | $71.13 | RVU26A |
| 2025-10-01 | $263.47 | $73.60 | RVU25D |
| 2025-07-01 | $263.47 | $73.60 | RVU25C |
| 2025-04-01 | $263.47 | $73.60 | RVU25B |
| 2025-01-01 | $263.47 | $73.60 | RVU25A |
| 2024-10-01 | $279.46 | $75.08 | RVU24D |
| 2024-07-01 | $279.46 | $75.08 | RVU24C |
| 2024-04-01 | $279.46 | $75.08 | RVU24B |
| 2024-03-09 | $279.46 | $75.08 | RVU24AR |
| 2024-01-01 | $274.90 | $73.85 | RVU24A |
| 2023-10-01 | $287.21 | $75.42 | RVU23D |
| 2023-07-01 | $287.21 | $75.42 | RVU23C |
| 2023-04-01 | $287.21 | $75.42 | RVU23B |
| 2023-01-01 | $287.21 | $75.42 | RVU23A |
| 2022-10-01 | $300.21 | $76.66 | RVU22D |
| 2022-07-01 | $300.21 | $76.66 | RVU22C |
| 2022-04-01 | $300.21 | $76.66 | RVU22B |
| 2022-01-01 | $300.21 | $76.66 | RVU22A |
| 2021-10-01 | $298.52 | $76.95 | RVU21D |
| 2021-07-01 | $298.52 | $76.95 | RVU21C |
| 2021-04-01 | $298.52 | $76.95 | RVU21B |
| 2021-01-01 | $298.52 | $76.95 | RVU21A |
| 2020-10-01 | $265.90 | $80.40 | RVU20D |
| 2020-07-01 | $265.90 | $80.40 | RVU20C |
| 2020-04-01 | $265.90 | $80.40 | RVU20B |
| 2020-01-01 | $265.90 | $80.40 | RVU20A |
| 2019-10-01 | $252.86 | $82.75 | RVU19D |
| 2019-07-01 | $252.86 | $82.75 | RVU19C |
| 2019-04-01 | $252.86 | $82.75 | RVU19B |
| 2019-01-01 | $252.86 | $82.75 | RVU19A |
| 2018-10-01 | $239.62 | $83.74 | RVU18D |
| 2018-07-01 | $239.62 | $83.74 | RVU18C |
| 2018-04-01 | $239.62 | $83.74 | RVU18B |
| 2018-01-01 | $239.62 | $83.74 | RVU18AR1 |
| 2017-10-01 | $234.20 | $82.03 | RVU17D |
| 2017-07-01 | $234.20 | $82.03 | RVU17C |
| 2017-04-01 | $234.20 | $82.03 | RVU17B |
| 2017-01-01 | $234.20 | $82.03 | RVU17A |
| 2016-10-01 | $231.84 | $80.39 | RVU16D |
| 2016-07-01 | $231.84 | $80.39 | RVU16C |
| 2016-04-01 | $231.84 | $80.39 | RVU16B |
| 2016-01-01 | $231.84 | $80.39 | RVU16A |
| 2015-10-01 | $232.60 | $80.60 | RVU15D |
| 2015-07-01 | $232.60 | $80.60 | RVU15C |
| 2015-04-01 | $231.44 | $80.20 | RVU15B |
| 2015-01-01 | $231.44 | $80.20 | RVU15A |
| 2014-10-01 | $231.28 | $80.83 | RVU14D |
| 2014-07-01 | $231.28 | $80.83 | RVU14C |
| 2014-04-01 | $231.28 | $80.83 | RVU14B |
| 2014-01-01 | $231.28 | $80.83 | RVU14A |
| 2013-10-01 | $239.99 | $79.06 | RVU13D |
| 2013-07-01 | $239.99 | $79.06 | RVU13C |
| 2013-04-01 | $239.99 | $79.06 | RVU13B |
| 2013-01-01 | $239.99 | $79.06 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
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