CPT code 46607: Anoscopy, high-resolution exam with biopsy2026 Medicare rate & RVUs in Puerto Rico
High-resolution anoscopy with biopsy examines the anal canal under magnification and collects tissue from suspicious areas, such as lesions evaluated for anal dysplasia.
In Puerto Rico, Medicare pays $232.29 for 46607 in the office and $113.42 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 46607 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 46607 covers
This service uses high-resolution magnification to inspect the anal canal and obtain one or more tissue samples from areas that look abnormal. It is commonly performed by colorectal surgeons and other clinicians trained in high-resolution anoscopy to evaluate findings such as abnormal anal cytology or suspected anal dysplasia. The magnified examination helps identify areas for biopsy; routine anoscopy with biopsy does not include this high-resolution component.
Report the code when the documented service includes both high-resolution anoscopy and biopsy. The record should identify the reason for examination, use of magnification, relevant findings, biopsy sites, and whether tissue was collected. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. A bilateral modifier is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery 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 Puerto Rico compares for 46607
Across 109 of 109 payment localities, the office rate for 46607 runs from $204.94 in Arkansas to $299.89 in San Benito County, CA. Puerto Rico pays $232.29. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$232.29
- Los Angeles, CA · California$257.64+$25.35
- Washington, DC area · District of Columbia$262.33+$30.04
- Miami, FL · Florida$252.23+$19.94
- Chicago, IL · Illinois$245.02+$12.73
- Manhattan, NY · New York$265.40+$33.11
- Alaska · Alaska$271.89+$39.60
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $207.83 | $104.96 |
| ArkansasArkansas | $204.94 | $103.94 |
| ArizonaArizona | $224.74 | $110.81 |
| Bakersfield, CACalifornia | $242.55 | $113.69 |
| Chico, CACalifornia | $241.67 | $112.81 |
| El Centro, CACalifornia | $241.72 | $112.86 |
| Fresno, CACalifornia | $241.67 | $112.81 |
| Hanford, CACalifornia | $241.67 | $112.81 |
| Madera, CACalifornia | $241.67 | $112.81 |
| Merced, CACalifornia | $241.67 | $112.81 |
| Modesto, CACalifornia | $241.67 | $112.81 |
| Napa, CACalifornia | $277.77 | $122.81 |
| Oxnard, CACalifornia | $256.15 | $117.18 |
| Redding, CACalifornia | $241.67 | $112.81 |
| Rest of CaliforniaCalifornia | $241.67 | $112.81 |
| Riverside, CACalifornia | $244.92 | $116.06 |
| Sacramento, CACalifornia | $253.02 | $116.28 |
| Salinas, CACalifornia | $252.06 | $115.80 |
| San Diego, CACalifornia | $257.56 | $116.95 |
| Marin County, CACalifornia | $293.28 | $127.50 |
| San Francisco, CACalifornia | $292.94 | $127.16 |
| San Benito County, CACalifornia | $299.89 | $130.36 |
| Santa Clara County, CACalifornia | $298.50 | $128.96 |
| San Luis Obispo, CACalifornia | $248.08 | $114.16 |
| Santa Cruz, CACalifornia | $259.69 | $116.84 |
| Santa Maria, CACalifornia | $252.89 | $115.80 |
| Santa Rosa, CACalifornia | $262.27 | $117.89 |
| Stockton, CACalifornia | $241.67 | $112.81 |
| Vallejo, CACalifornia | $277.28 | $122.32 |
| Visalia, CACalifornia | $241.67 | $112.81 |
| Yuba City, CACalifornia | $241.67 | $112.81 |
| ColoradoColorado | $239.00 | $113.91 |
| ConnecticutConnecticut | $245.81 | $119.19 |
| DelawareDelaware | $228.36 | $112.20 |
| Fort Lauderdale, FLFlorida | $240.83 | $121.73 |
| Rest of FloridaFlorida | $229.29 | $116.89 |
| Atlanta, GAGeorgia | $235.41 | $115.96 |
| Rest of GeorgiaGeorgia | $216.64 | $111.76 |
| Hawaii, Guam, HIHawaii | $246.99 | $113.31 |
| IowaIowa | $212.10 | $104.52 |
| IdahoIdaho | $213.60 | $105.44 |
| East St. Louis, ILIllinois | $229.04 | $120.88 |
| Rest of IllinoisIllinois | $223.48 | $116.14 |
| Suburban Chicago, ILIllinois | $243.06 | $122.32 |
| IndianaIndiana | $214.78 | $105.79 |
| KansasKansas | $211.53 | $105.24 |
| KentuckyKentucky | $213.41 | $108.89 |
| New Orleans, LALouisiana | $223.37 | $112.74 |
| Rest of LouisianaLouisiana | $213.25 | $109.20 |
| Metropolitan Boston, MAMassachusetts | $261.54 | $121.16 |
| Rest of MassachusettsMassachusetts | $237.81 | $114.01 |
| Baltimore area, MDMaryland | $245.20 | $119.04 |
| Rest of MarylandMaryland | $232.48 | $113.50 |
| Rest of MaineMaine | $215.10 | $106.93 |
| Southern Maine, MEMaine | $225.76 | $109.25 |
| Detroit, MIMichigan | $232.46 | $119.00 |
| Rest of MichiganMichigan | $219.13 | $111.79 |
| MinnesotaMinnesota | $228.07 | $107.09 |
| Metropolitan Kansas City, MOMissouri | $221.48 | $111.08 |
| Metropolitan St. Louis, MOMissouri | $223.67 | $111.74 |
| Rest of MissouriMissouri | $209.98 | $108.64 |
| MississippiMississippi | $207.48 | $106.25 |
| MontanaMontana | $230.78 | $113.21 |
| North CarolinaNorth Carolina | $217.20 | $107.51 |
| North DakotaNorth Dakota | $224.85 | $107.28 |
| NebraskaNebraska | $213.10 | $104.58 |
| New HampshireNew Hampshire | $235.66 | $113.26 |
| Northern New JerseyNew Jersey | $259.84 | $123.46 |
| Rest of New JerseyNew Jersey | $248.35 | $119.96 |
| New MexicoNew Mexico | $220.45 | $112.64 |
| NevadaNevada | $229.28 | $111.59 |
| NYC suburbs and Long Island, NYNew York | $272.14 | $132.35 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $250.29 | $121.55 |
| Queens, NYNew York | $266.94 | $127.97 |
| Rest of New YorkNew York | $220.38 | $108.68 |
| OhioOhio | $217.92 | $110.58 |
| OklahomaOklahoma | $212.63 | $107.64 |
| Portland, OROregon | $245.92 | $115.30 |
| Rest of OregonOregon | $227.23 | $110.13 |
| Metropolitan Philadelphia, PAPennsylvania | $240.13 | $117.74 |
| Rest of PennsylvaniaPennsylvania | $218.03 | $110.10 |
| Rhode IslandRhode Island | $236.00 | $114.55 |
| South CarolinaSouth Carolina | $217.98 | $109.34 |
| South DakotaSouth Dakota | $224.15 | $106.58 |
| TennesseeTennessee | $212.60 | $105.73 |
| Austin, TXTexas | $238.44 | $114.05 |
| Beaumont, TXTexas | $216.68 | $109.69 |
| Brazoria, TXTexas | $227.83 | $111.32 |
| Dallas, TXTexas | $229.43 | $112.33 |
| Fort Worth, TXTexas | $228.07 | $112.14 |
| Galveston, TXTexas | $228.61 | $111.86 |
| Houston, TXTexas | $234.10 | $117.35 |
| Rest of TexasTexas | $222.23 | $110.66 |
| UtahUtah | $220.84 | $110.32 |
| VirginiaVirginia | $225.32 | $109.75 |
| Virgin Islands, VIUnited States Virgin Islands | $232.29 | $113.42 |
| VermontVermont | $224.36 | $107.97 |
| Rest of WashingtonWashington | $237.23 | $113.43 |
| King County, WAWashington | $266.37 | $122.11 |
| WisconsinWisconsin | $217.61 | $104.98 |
| West VirginiaWest Virginia | $215.60 | $113.43 |
| WyomingWyoming | $228.19 | $110.62 |
46607 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.
$204.94
$271.89
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 | $271.89 | 1 |
| AL | $207.83 | 1 |
| AR | $204.94 | 1 |
| AZ | $224.74 | 1 |
| CA | $241.67–$299.89 | 29 |
| CO | $239.00 | 1 |
| CT | $245.81 | 1 |
| DC | $262.33 | 1 |
| DE | $228.36 | 1 |
| FL | $229.29–$252.23 | 3 |
| GA | $216.64–$235.41 | 2 |
| GU | $246.99 | 1 |
| HI | $246.99 | 1 |
| IA | $212.10 | 1 |
| ID | $213.60 | 1 |
| IL | $223.48–$245.02 | 4 |
| IN | $214.78 | 1 |
| KS | $211.53 | 1 |
| KY | $213.41 | 1 |
| LA | $213.25–$223.37 | 2 |
| MA | $237.81–$261.54 | 2 |
| MD | $232.48–$262.33 | 3 |
| ME | $215.10–$225.76 | 2 |
| MI | $219.13–$232.46 | 2 |
| MN | $228.07 | 1 |
| MO | $209.98–$223.67 | 3 |
| MS | $207.48 | 1 |
| MT | $230.78 | 1 |
| NC | $217.20 | 1 |
| ND | $224.85 | 1 |
| NE | $213.10 | 1 |
| NH | $235.66 | 1 |
| NJ | $248.35–$259.84 | 2 |
| NM | $220.45 | 1 |
| NV | $229.28 | 1 |
| NY | $220.38–$272.14 | 5 |
| OH | $217.92 | 1 |
| OK | $212.63 | 1 |
| OR | $227.23–$245.92 | 2 |
| PA | $218.03–$240.13 | 2 |
| PR | $232.29 | 1 |
| RI | $236.00 | 1 |
| SC | $217.98 | 1 |
| SD | $224.15 | 1 |
| TN | $212.60 | 1 |
| TX | $216.68–$238.44 | 8 |
| UT | $220.84 | 1 |
| VA | $225.32–$262.33 | 2 |
| VI | $232.29 | 1 |
| VT | $224.36 | 1 |
| WA | $237.23–$266.37 | 2 |
| WI | $217.61 | 1 |
| WV | $215.60 | 1 |
| WY | $228.19 | 1 |
How the 46607 rate is calculated
Each of 46607’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 · 46607
RVUs × geographic indexes × conversion factor
Work2.15
2.15 RVUs× 1.000 GPCI
Practice expense4.46
4.46 RVUs× 1.000 GPCI
Malpractice0.30
0.30 RVUs× 1.000 GPCI
Adjusted RVUs
6.9100
Conversion factor
$33.4009
Medicare rate
$230.80
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,602
- Code
- 46607
- Physician work
- 2.15
- Practice expense
- 4.46
- Malpractice
- 0.30
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.15 | × 1.000 | 2.1500 |
| Practice expense | 4.46 | × 1.011 | 4.5091 |
| Malpractice | 0.30 | × 0.985 | 0.2955 |
| Total RVUs | 6.9546 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$232.29
Office: (2.15 × 1 + 4.46 × 1.011 + 0.3 × 0.985) × $33.4009 = $232.29
Facility: (2.15 × 1 + 0.94 × 1.011 + 0.3 × 0.985) × $33.4009 = $113.42
Payment rules and modifiers for 46607
The CMS indicators that decide how 46607 is paid alongside other services.
CMS payment indicators · 46607
Anoscopy, high-resolution exam with biopsy
| 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
46607 without 51 · national office
$230.80
Anoscopy, high-resolution exam with biopsy
46607-51 · Second procedure: 50%
$115.40
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 46607 has changed in Puerto Rico
46607 · Office / nonfacility
$232.29
Effective 2026-10-01
The base rate is $32.70 higher than on 2025-10-01, moving from $199.59 to $232.29 (16.4%).
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
$199.59changed to$232.29
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.20 changed to 2.15
- Practice expense RVU 3.66 changed to 4.46
- Malpractice RVU 0.29 changed to 0.30
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$208.05changed to$199.59
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.71 changed to 3.66
- Malpractice RVU 0.32 changed to 0.29
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$204.66changed to$208.05
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$210.94changed to$204.66
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.70 changed to 3.71
- Malpractice RVU 0.30 changed to 0.32
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$210.10changed to$210.94
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$221.01changed to$210.10
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.85 changed to 3.70
- Malpractice RVU 0.31 changed to 0.30
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$219.32changed to$221.01
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.74 changed to 3.85
- Malpractice RVU 0.32 changed to 0.31
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$208.34changed to$219.32
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.27 changed to 3.74
- Malpractice RVU 0.28 changed to 0.32
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$202.15changed to$208.34
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.12 changed to 3.27
- Malpractice RVU 0.27 changed to 0.28
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$197.95changed to$202.15
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.02 changed to 3.12
- Malpractice RVU 0.26 changed to 0.27
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$178.11changed to$197.95
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.04 changed to 3.02
- Malpractice RVU 0.25 changed to 0.26
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$157.96changed to$178.11
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.05 changed to 3.04
- Malpractice RVU 0.21 changed to 0.25
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
No ratechanged to$157.96
Held through RVU16B, RVU16C, RVU16D.
January 1, 2015
RVU15A
No ratechanged toNo rate
Held through RVU15B, RVU15C, RVU15D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $232.29 | $113.42 | RVU26D |
| 2026-07-01 | $232.29 | $113.42 | RVU26C |
| 2026-04-01 | $232.29 | $113.42 | RVU26B |
| 2026-01-01 | $232.29 | $113.42 | RVU26A |
| 2025-10-01 | $199.59 | $120.11 | RVU25D |
| 2025-07-01 | $199.59 | $120.11 | RVU25C |
| 2025-04-01 | $199.59 | $120.11 | RVU25B |
| 2025-01-01 | $199.59 | $120.11 | RVU25A |
| 2024-10-01 | $208.05 | $123.92 | RVU24D |
| 2024-07-01 | $208.05 | $123.92 | RVU24C |
| 2024-04-01 | $208.05 | $123.92 | RVU24B |
| 2024-03-09 | $208.05 | $123.92 | RVU24AR |
| 2024-01-01 | $204.66 | $121.89 | RVU24A |
| 2023-10-01 | $210.94 | $124.86 | RVU23D |
| 2023-07-01 | $210.10 | $124.70 | RVU23C |
| 2023-04-01 | $210.10 | $124.70 | RVU23B |
| 2023-01-01 | $210.10 | $124.70 | RVU23A |
| 2022-10-01 | $221.01 | $129.62 | RVU22D |
| 2022-07-01 | $221.01 | $129.62 | RVU22C |
| 2022-04-01 | $221.01 | $129.62 | RVU22B |
| 2022-01-01 | $221.01 | $129.62 | RVU22A |
| 2021-10-01 | $219.32 | $130.68 | RVU21D |
| 2021-07-01 | $219.32 | $130.68 | RVU21C |
| 2021-04-01 | $219.32 | $130.68 | RVU21B |
| 2021-01-01 | $219.32 | $130.68 | RVU21A |
| 2020-10-01 | $208.34 | $131.94 | RVU20D |
| 2020-07-01 | $208.34 | $131.94 | RVU20C |
| 2020-04-01 | $208.34 | $131.94 | RVU20B |
| 2020-01-01 | $208.34 | $131.94 | RVU20A |
| 2019-10-01 | $202.15 | $131.38 | RVU19D |
| 2019-07-01 | $202.15 | $131.38 | RVU19C |
| 2019-04-01 | $202.15 | $131.38 | RVU19B |
| 2019-01-01 | $202.15 | $131.38 | RVU19A |
| 2018-10-01 | $197.95 | $132.33 | RVU18D |
| 2018-07-01 | $197.95 | $132.33 | RVU18C |
| 2018-04-01 | $197.95 | $132.33 | RVU18B |
| 2018-01-01 | $197.95 | $132.33 | RVU18AR1 |
| 2017-10-01 | $178.11 | $122.50 | RVU17D |
| 2017-07-01 | $178.11 | $122.50 | RVU17C |
| 2017-04-01 | $178.11 | $122.50 | RVU17B |
| 2017-01-01 | $178.11 | $122.50 | RVU17A |
| 2016-10-01 | $157.96 | $112.02 | RVU16D |
| 2016-07-01 | $157.96 | $112.02 | RVU16C |
| 2016-04-01 | $157.96 | $112.02 | RVU16B |
| 2016-01-01 | $157.96 | $112.02 | RVU16A |
| 2015-10-01 | Separate payment rules apply | Separate payment rules apply | RVU15D |
| 2015-07-01 | Separate payment rules apply | Separate payment rules apply | RVU15C |
| 2015-04-01 | Separate payment rules apply | Separate payment rules apply | RVU15B |
| 2015-01-01 | Separate payment rules apply | Separate payment rules apply | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
46607 billing questions
How does this differ from anoscopy with biopsy without high-resolution magnification?
This code includes high-resolution magnification as well as biopsy. Use the standard anoscopy biopsy code when biopsy is performed without that magnified examination.
Can the high-resolution examination be reported separately when a biopsy is taken?
The biopsy code includes the high-resolution examination. Do not separately report the high-resolution anoscopy-only service for the same examination.
Does the code include pathology analysis of the biopsy?
It covers the anoscopy and tissue collection, not the laboratory’s histologic examination of the specimen. Pathology may be reported by the provider or laboratory performing that separate service.
How many units are reported when multiple areas are biopsied?
The code covers single or multiple biopsies during the high-resolution anoscopy session; the number of tissue samples does not determine units.
Can modifier 50 or an assistant-at-surgery modifier be used?
No. CMS identifies bilateral adjustment as inappropriate for this code and does not pay an assistant at surgery for it.
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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