CPT code 46610: Anoscopy, hot forceps or bipolar cautery2026 Medicare rate & RVUs in Visalia, CA
Reports anoscopic removal of an anal canal lesion using hot biopsy forceps or bipolar cautery, rather than biopsy alone or another removal technique.
In Visalia, CA, Medicare pays $327.72 for 46610 in the office and $75.86 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 46610 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 46610 covers
A clinician examines the anal canal through an anoscope and removes a tumor, polyp, or other lesion using hot biopsy forceps or bipolar cautery. Colorectal surgeons and other clinicians who perform anorectal procedures may provide this service in an office or facility setting. The code is specific to removal with these cautery techniques; a lesion sampled for diagnosis without removal is a different service, as is removal by snare or laser.
Select this code when the procedure record supports both anoscopic access and removal using the specified technique. Document the lesion treated and how it was removed. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS applies endoscopy-family pricing. Modifier 50 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 Visalia, CA compares for 46610
Across 109 of 109 payment localities, the office rate for 46610 runs from $266.06 in Arkansas to $420.36 in San Benito County, CA. Visalia, CA pays $327.72. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Visalia, CA · this page$327.72
- Bakersfield, CA · California$328.37+$0.65
- Chico, CA · California$327.72
- El Centro, CA · California$327.76+$0.04
- Fresno, CA · California$327.72
- Hanford, CA · California$327.72
- Los Angeles, CA · California$352.03+$24.31
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $327.72 | $75.86 |
| Merced, CACalifornia | $327.72 | $75.86 |
| Modesto, CACalifornia | $327.72 | $75.86 |
| Napa, CACalifornia | $386.38 | $83.50 |
| Oxnard, CACalifornia | $350.91 | $79.29 |
| Redding, CACalifornia | $327.72 | $75.86 |
| Rest of CaliforniaCalifornia | $327.72 | $75.86 |
| Riverside, CACalifornia | $330.20 | $78.34 |
| Sacramento, CACalifornia | $345.70 | $78.45 |
| Salinas, CACalifornia | $344.47 | $78.13 |
| San Diego, CACalifornia | $353.96 | $79.13 |
| Marin County, CACalifornia | $410.94 | $86.92 |
| San Francisco, CACalifornia | $410.67 | $86.66 |
| San Benito County, CACalifornia | $420.36 | $88.99 |
| Santa Clara County, CACalifornia | $419.29 | $87.92 |
| San Luis Obispo, CACalifornia | $338.75 | $77.01 |
| Santa Cruz, CACalifornia | $358.42 | $79.21 |
| Santa Maria, CACalifornia | $346.14 | $78.19 |
| Santa Rosa, CACalifornia | $362.13 | $79.93 |
| Stockton, CACalifornia | $327.72 | $75.86 |
| Vallejo, CACalifornia | $386.00 | $83.13 |
| Yuba City, CACalifornia | $327.72 | $75.86 |
| Washington, DC areaDistrict of Columbia | $354.74 | $84.03 |
| Miami, FLFlorida | $328.22 | $89.00 |
| Chicago, ILIllinois | $317.48 | $86.53 |
| Manhattan, NYNew York | $354.68 | $87.66 |
| AlaskaAlaska | $340.05 | $95.32 |
| AlabamaAlabama | $270.55 | $69.48 |
| ArkansasArkansas | $266.06 | $68.66 |
| ArizonaArizona | $296.89 | $74.22 |
| ColoradoColorado | $321.19 | $76.68 |
| ConnecticutConnecticut | $328.15 | $80.66 |
| DelawareDelaware | $302.31 | $75.27 |
| Fort Lauderdale, FLFlorida | $315.49 | $82.71 |
| Rest of FloridaFlorida | $298.53 | $78.84 |
| Atlanta, GAGeorgia | $311.73 | $78.25 |
| Rest of GeorgiaGeorgia | $279.72 | $74.74 |
| Hawaii, Guam, HIHawaii | $337.86 | $76.58 |
| IowaIowa | $279.52 | $69.25 |
| IdahoIdaho | $281.38 | $69.97 |
| East St. Louis, ILIllinois | $293.22 | $81.81 |
| Rest of IllinoisIllinois | $287.96 | $78.15 |
| Suburban Chicago, ILIllinois | $319.10 | $83.10 |
| IndianaIndiana | $283.28 | $70.25 |
| KansasKansas | $277.52 | $69.78 |
| KentuckyKentucky | $276.83 | $72.54 |
| New Orleans, LALouisiana | $291.86 | $75.62 |
| Rest of LouisianaLouisiana | $276.13 | $72.76 |
| Metropolitan Boston, MAMassachusetts | $356.58 | $82.20 |
| Rest of MassachusettsMassachusetts | $318.66 | $76.68 |
| Baltimore area, MDMaryland | $327.17 | $80.59 |
| Rest of MarylandMaryland | $308.82 | $76.26 |
| Rest of MaineMaine | $282.53 | $71.11 |
| Southern Maine, MEMaine | $300.81 | $73.08 |
| Detroit, MIMichigan | $302.24 | $80.49 |
| Rest of MichiganMichigan | $284.63 | $74.82 |
| MinnesotaMinnesota | $307.98 | $71.52 |
| Metropolitan Kansas City, MOMissouri | $290.13 | $74.35 |
| Metropolitan St. Louis, MOMissouri | $293.65 | $74.89 |
| Rest of MissouriMissouri | $270.35 | $72.27 |
| MississippiMississippi | $268.29 | $70.43 |
| MontanaMontana | $305.94 | $76.14 |
| North CarolinaNorth Carolina | $285.99 | $71.59 |
| North DakotaNorth Dakota | $301.39 | $71.59 |
| NebraskaNebraska | $281.42 | $69.32 |
| New HampshireNew Hampshire | $315.51 | $76.29 |
| Northern New JerseyNew Jersey | $350.15 | $83.58 |
| Rest of New JerseyNew Jersey | $331.97 | $81.03 |
| New MexicoNew Mexico | $286.21 | $75.48 |
| NevadaNevada | $304.93 | $74.90 |
| NYC suburbs and Long Island, NYNew York | $363.69 | $90.46 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $333.81 | $82.18 |
| Queens, NYNew York | $358.71 | $87.08 |
| Rest of New YorkNew York | $290.84 | $72.54 |
| OhioOhio | $283.70 | $73.89 |
| OklahomaOklahoma | $276.79 | $71.58 |
| Portland, OROregon | $333.13 | $77.82 |
| Rest of OregonOregon | $302.64 | $73.77 |
| Metropolitan Philadelphia, PAPennsylvania | $318.70 | $79.48 |
| Rest of PennsylvaniaPennsylvania | $284.50 | $73.54 |
| Puerto RicoPuerto Rico | $308.66 | $76.33 |
| Rhode IslandRhode Island | $314.38 | $77.00 |
| South CarolinaSouth Carolina | $285.30 | $72.97 |
| South DakotaSouth Dakota | $300.85 | $71.05 |
| TennesseeTennessee | $279.05 | $70.17 |
| Austin, TXTexas | $320.04 | $76.91 |
| Beaumont, TXTexas | $282.32 | $73.20 |
| Brazoria, TXTexas | $302.29 | $74.56 |
| Dallas, TXTexas | $304.21 | $75.33 |
| Fort Worth, TXTexas | $301.75 | $75.16 |
| Galveston, TXTexas | $303.17 | $74.98 |
| Houston, TXTexas | $307.38 | $79.19 |
| Rest of TexasTexas | $292.12 | $74.05 |
| UtahUtah | $289.78 | $73.77 |
| VirginiaVirginia | $299.33 | $73.44 |
| Virgin Islands, VIUnited States Virgin Islands | $308.66 | $76.33 |
| VermontVermont | $299.59 | $72.09 |
| Rest of WashingtonWashington | $318.25 | $76.28 |
| King County, WAWashington | $364.86 | $82.90 |
| WisconsinWisconsin | $289.86 | $69.72 |
| West VirginiaWest Virginia | $275.66 | $75.96 |
| WyomingWyoming | $303.95 | $74.16 |
46610 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.
$266.06
$374.04
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 | $340.05 | 1 |
| AL | $270.55 | 1 |
| AR | $266.06 | 1 |
| AZ | $296.89 | 1 |
| CA | $327.72–$420.36 | 29 |
| CO | $321.19 | 1 |
| CT | $328.15 | 1 |
| DC | $354.74 | 1 |
| DE | $302.31 | 1 |
| FL | $298.53–$328.22 | 3 |
| GA | $279.72–$311.73 | 2 |
| GU | $337.86 | 1 |
| HI | $337.86 | 1 |
| IA | $279.52 | 1 |
| ID | $281.38 | 1 |
| IL | $287.96–$319.10 | 4 |
| IN | $283.28 | 1 |
| KS | $277.52 | 1 |
| KY | $276.83 | 1 |
| LA | $276.13–$291.86 | 2 |
| MA | $318.66–$356.58 | 2 |
| MD | $308.82–$354.74 | 3 |
| ME | $282.53–$300.81 | 2 |
| MI | $284.63–$302.24 | 2 |
| MN | $307.98 | 1 |
| MO | $270.35–$293.65 | 3 |
| MS | $268.29 | 1 |
| MT | $305.94 | 1 |
| NC | $285.99 | 1 |
| ND | $301.39 | 1 |
| NE | $281.42 | 1 |
| NH | $315.51 | 1 |
| NJ | $331.97–$350.15 | 2 |
| NM | $286.21 | 1 |
| NV | $304.93 | 1 |
| NY | $290.84–$363.69 | 5 |
| OH | $283.70 | 1 |
| OK | $276.79 | 1 |
| OR | $302.64–$333.13 | 2 |
| PA | $284.50–$318.70 | 2 |
| PR | $308.66 | 1 |
| RI | $314.38 | 1 |
| SC | $285.30 | 1 |
| SD | $300.85 | 1 |
| TN | $279.05 | 1 |
| TX | $282.32–$320.04 | 8 |
| UT | $289.78 | 1 |
| VA | $299.33–$354.74 | 2 |
| VI | $308.66 | 1 |
| VT | $299.59 | 1 |
| WA | $318.25–$364.86 | 2 |
| WI | $289.86 | 1 |
| WV | $275.66 | 1 |
| WY | $303.95 | 1 |
How the 46610 rate is calculated
Each of 46610’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 · 46610
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense7.68
7.68 RVUs× 1.000 GPCI
Malpractice0.23
0.23 RVUs× 1.000 GPCI
Adjusted RVUs
9.1600
Conversion factor
$33.4009
Medicare rate
$305.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Visalia, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,604
- Code
- 46610
- Physician work
- 1.25
- Practice expense
- 7.68
- Malpractice
- 0.23
GPCI2026.csv
34
- Locality
- Visalia, CA
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.017 | 1.2712 |
| Practice expense | 7.68 | × 1.096 | 8.4173 |
| Malpractice | 0.23 | × 0.536 | 0.1233 |
| Total RVUs | 9.8118 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Visalia, CA$327.72
Office: (1.25 × 1.017 + 7.68 × 1.096 + 0.23 × 0.536) × $33.4009 = $327.72
Facility: (1.25 × 1.017 + 0.8 × 1.096 + 0.23 × 0.536) × $33.4009 = $75.86
Payment rules and modifiers for 46610
The CMS indicators that decide how 46610 is paid alongside other services.
CMS payment indicators · 46610
Anoscopy, hot forceps or bipolar cautery
| 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
46610 without 51 · national office
$305.95
Anoscopy, hot forceps or bipolar cautery
46610-51 · Second procedure: 50%
$152.98
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 46610 has changed in Visalia, CA
46610 · Office / nonfacility
$327.72
Effective 2026-10-01
The base rate is $50.35 higher than on 2025-10-01, moving from $277.37 to $327.72 (18.2%).
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
$277.37changed to$327.72
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.28 changed to 1.25
- Practice expense RVU 6.54 changed to 7.68
- Work GPCI 1.014 changed to 1.017
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.560 changed to 0.536
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$291.45changed to$277.37
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 6.70 changed to 6.54
- Malpractice RVU 0.24 changed to 0.23
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$286.69changed to$291.45
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$300.02changed to$286.69
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 6.86 changed to 6.70
- Malpractice RVU 0.25 changed to 0.24
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.579 changed to 0.560
January 1, 2023
RVU23A
$310.12changed to$300.02
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 7.04 changed to 6.86
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.597 changed to 0.579
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$309.67changed to$310.12
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 6.97 changed to 7.04
- Malpractice RVU 0.23 changed to 0.25
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$275.35changed to$309.67
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 5.77 changed to 6.97
- Malpractice RVU 0.25 changed to 0.23
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.580 changed to 0.597
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$259.58changed to$275.35
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 5.36 changed to 5.77
- Work GPCI 1.020 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.562 changed to 0.580
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$247.51changed to$259.58
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.05 changed to 5.36
- Malpractice RVU 0.26 changed to 0.25
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$244.42changed to$247.51
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 4.95 changed to 5.05
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.610 changed to 0.562
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$244.42
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $327.72 | $75.86 | RVU26D |
| 2026-07-01 | $327.72 | $75.86 | RVU26C |
| 2026-04-01 | $327.72 | $75.86 | RVU26B |
| 2026-01-01 | $327.72 | $75.86 | RVU26A |
| 2025-10-01 | $277.37 | $78.32 | RVU25D |
| 2025-07-01 | $277.37 | $78.32 | RVU25C |
| 2025-04-01 | $277.37 | $78.32 | RVU25B |
| 2025-01-01 | $277.37 | $78.32 | RVU25A |
| 2024-10-01 | $291.45 | $79.70 | RVU24D |
| 2024-07-01 | $291.45 | $79.70 | RVU24C |
| 2024-04-01 | $291.45 | $79.70 | RVU24B |
| 2024-03-09 | $291.45 | $79.70 | RVU24AR |
| 2024-01-01 | $286.69 | $78.39 | RVU24A |
| 2023-10-01 | $300.02 | $80.64 | RVU23D |
| 2023-07-01 | $300.02 | $80.64 | RVU23C |
| 2023-04-01 | $300.02 | $80.64 | RVU23B |
| 2023-01-01 | $300.02 | $80.64 | RVU23A |
| 2022-10-01 | $310.12 | $81.62 | RVU22D |
| 2022-07-01 | $310.12 | $81.62 | RVU22C |
| 2022-04-01 | $310.12 | $81.62 | RVU22B |
| 2022-01-01 | $310.12 | $81.62 | RVU22A |
| 2021-10-01 | $309.67 | $81.50 | RVU21D |
| 2021-07-01 | $309.67 | $81.50 | RVU21C |
| 2021-04-01 | $309.67 | $81.50 | RVU21B |
| 2021-01-01 | $309.67 | $81.50 | RVU21A |
| 2020-10-01 | $275.35 | $83.82 | RVU20D |
| 2020-07-01 | $275.35 | $83.82 | RVU20C |
| 2020-04-01 | $275.35 | $83.82 | RVU20B |
| 2020-01-01 | $275.35 | $83.82 | RVU20A |
| 2019-10-01 | $259.58 | $82.69 | RVU19D |
| 2019-07-01 | $259.58 | $82.69 | RVU19C |
| 2019-04-01 | $259.58 | $82.69 | RVU19B |
| 2019-01-01 | $259.58 | $82.69 | RVU19A |
| 2018-10-01 | $247.51 | $83.58 | RVU18D |
| 2018-07-01 | $247.51 | $83.58 | RVU18C |
| 2018-04-01 | $247.51 | $83.58 | RVU18B |
| 2018-01-01 | $247.51 | $83.58 | RVU18AR1 |
| 2017-10-01 | $244.42 | $84.49 | RVU17D |
| 2017-07-01 | $244.42 | $84.49 | RVU17C |
| 2017-04-01 | $244.42 | $84.49 | RVU17B |
| 2017-01-01 | $244.42 | $84.49 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Visalia, CA rate applies
Visalia, CA is a Medicare payment area, not a city. Our Census mapping connects it to 70 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Visalia
- Allensworth
- Alpaugh
- California Hot Springs
- Camp Nelson
- Cedar Slope
- Cutler
- Delft Colony
46610 billing questions
When should this code be chosen instead of an anoscopy with biopsy?
Use this code when the lesion is removed with hot biopsy forceps or bipolar cautery. An anoscopic biopsy code describes sampling tissue rather than the removal reported here.
How does this differ from anoscopic removal by snare or laser?
The method determines the code: this code is for hot biopsy forceps or bipolar cautery. Snare and laser removal are represented by separate technique-specific codes.
Is diagnostic anoscopy separately reported with lesion removal?
When related endoscopies are performed together, CMS applies endoscopy-family pricing. The diagnostic examination is part of the same procedural session, not an unrelated service.
Should modifier 50 be used for lesions on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
What should the procedure note establish?
Document the anal canal lesion treated and that removal was performed through an anoscope using hot biopsy forceps or bipolar cautery.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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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