CPT code 46611: Anoscopy, snare lesion removal2026 Medicare rate & RVUs in Marin County, CA
Anoscopy with snare excision removes a tumor, polyp, or other lesion from the anal canal when the clinician uses snare technique.
In Marin County, CA, Medicare pays $320.78 for 46611 in the office and $85.78 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 46611 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 46611 covers
The clinician examines the anal canal with an anoscope and removes a tumor, polyp, or other lesion using a snare. Colorectal surgeons and gastroenterologists commonly perform this focused anorectal procedure in an office procedure room or facility setting. It is distinct from diagnostic-only anoscopy and from removal by other techniques.
Document the lesion treated and the snare technique used. Do not separately report diagnostic anoscopy as though it were a separate service when it is part of the removal. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this anatomy and service. Medicare does not pay an assistant at surgery for this code; 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 Marin County, CA compares for 46611
Across 109 of 109 payment localities, the office rate for 46611 runs from $211.12 in Arkansas to $328.09 in San Benito County, CA. Marin County, CA pays $320.78. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Marin County, CA · this page$320.78
- Bakersfield, CA · California$258.15−$62.63
- Chico, CA · California$257.58−$63.20
- El Centro, CA · California$257.61−$63.17
- Fresno, CA · California$257.58−$63.20
- Hanford, CA · California$257.58−$63.20
- Los Angeles, CA · California$276.19−$44.59
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $257.58 | $74.91 |
| Merced, CACalifornia | $257.58 | $74.91 |
| Modesto, CACalifornia | $257.58 | $74.91 |
| Napa, CACalifornia | $302.05 | $82.38 |
| Oxnard, CACalifornia | $275.17 | $78.17 |
| Redding, CACalifornia | $257.58 | $74.91 |
| Rest of CaliforniaCalifornia | $257.58 | $74.91 |
| Riverside, CACalifornia | $259.74 | $77.07 |
| Sacramento, CACalifornia | $271.28 | $77.44 |
| Salinas, CACalifornia | $270.29 | $77.12 |
| San Diego, CACalifornia | $277.41 | $78.07 |
| San Francisco, CACalifornia | $320.56 | $85.55 |
| San Benito County, CACalifornia | $328.09 | $87.75 |
| Santa Clara County, CACalifornia | $327.16 | $86.82 |
| San Luis Obispo, CACalifornia | $265.85 | $76.01 |
| Santa Cruz, CACalifornia | $280.64 | $78.14 |
| Santa Maria, CACalifornia | $271.51 | $77.18 |
| Santa Rosa, CACalifornia | $283.53 | $78.85 |
| Stockton, CACalifornia | $257.58 | $74.91 |
| Vallejo, CACalifornia | $301.73 | $82.05 |
| Visalia, CACalifornia | $257.58 | $74.91 |
| Yuba City, CACalifornia | $257.58 | $74.91 |
| Washington, DC areaDistrict of Columbia | $278.78 | $82.44 |
| Miami, FLFlorida | $259.59 | $86.09 |
| Chicago, ILIllinois | $251.40 | $83.89 |
| Manhattan, NYNew York | $279.28 | $85.61 |
| AlaskaAlaska | $272.20 | $94.70 |
| AlabamaAlabama | $214.54 | $68.70 |
| ArkansasArkansas | $211.12 | $67.95 |
| ArizonaArizona | $234.56 | $73.06 |
| ColoradoColorado | $252.85 | $75.51 |
| ConnecticutConnecticut | $258.55 | $79.05 |
| DelawareDelaware | $238.72 | $74.05 |
| Fort Lauderdale, FLFlorida | $249.39 | $80.55 |
| Rest of FloridaFlorida | $236.38 | $77.05 |
| Atlanta, GAGeorgia | $246.04 | $76.70 |
| Rest of GeorgiaGeorgia | $221.99 | $73.32 |
| Hawaii, Guam, HIHawaii | $265.03 | $75.53 |
| IowaIowa | $221.11 | $68.60 |
| IdahoIdaho | $222.58 | $69.24 |
| East St. Louis, ILIllinois | $232.87 | $79.53 |
| Rest of IllinoisIllinois | $228.51 | $76.34 |
| Suburban Chicago, ILIllinois | $252.14 | $80.97 |
| IndianaIndiana | $224.01 | $69.51 |
| KansasKansas | $219.71 | $69.04 |
| KentuckyKentucky | $219.57 | $71.40 |
| New Orleans, LALouisiana | $231.05 | $74.21 |
| Rest of LouisianaLouisiana | $219.08 | $71.58 |
| Metropolitan Boston, MAMassachusetts | $279.82 | $80.81 |
| Rest of MassachusettsMassachusetts | $251.01 | $75.50 |
| Baltimore area, MDMaryland | $257.79 | $78.96 |
| Rest of MarylandMaryland | $243.67 | $75.00 |
| Rest of MaineMaine | $223.57 | $70.24 |
| Southern Maine, MEMaine | $237.29 | $72.12 |
| Detroit, MIMichigan | $239.34 | $78.50 |
| Rest of MichiganMichigan | $225.61 | $73.44 |
| MinnesotaMinnesota | $242.36 | $70.86 |
| Metropolitan Kansas City, MOMissouri | $229.60 | $73.10 |
| Metropolitan St. Louis, MOMissouri | $232.27 | $73.60 |
| Rest of MissouriMissouri | $214.77 | $71.10 |
| MississippiMississippi | $213.00 | $69.50 |
| MontanaMontana | $241.48 | $74.80 |
| North CarolinaNorth Carolina | $226.19 | $70.68 |
| North DakotaNorth Dakota | $237.52 | $70.85 |
| NebraskaNebraska | $222.52 | $68.68 |
| New HampshireNew Hampshire | $248.54 | $75.04 |
| Northern New JerseyNew Jersey | $275.40 | $82.06 |
| Rest of New JerseyNew Jersey | $261.53 | $79.53 |
| New MexicoNew Mexico | $226.86 | $74.03 |
| NevadaNevada | $240.57 | $73.73 |
| NYC suburbs and Long Island, NYNew York | $286.29 | $88.12 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $263.08 | $80.57 |
| Queens, NYNew York | $282.17 | $85.17 |
| Rest of New YorkNew York | $229.89 | $71.55 |
| OhioOhio | $224.80 | $72.63 |
| OklahomaOklahoma | $219.41 | $70.58 |
| Portland, OROregon | $261.81 | $76.64 |
| Rest of OregonOregon | $238.73 | $72.73 |
| Metropolitan Philadelphia, PAPennsylvania | $251.43 | $77.93 |
| Rest of PennsylvaniaPennsylvania | $225.35 | $72.34 |
| Puerto RicoPuerto Rico | $243.50 | $75.00 |
| Rhode IslandRhode Island | $247.92 | $75.75 |
| South CarolinaSouth Carolina | $225.86 | $71.86 |
| South DakotaSouth Dakota | $237.05 | $70.38 |
| TennesseeTennessee | $220.89 | $69.38 |
| Austin, TXTexas | $251.97 | $75.63 |
| Beaumont, TXTexas | $223.70 | $72.03 |
| Brazoria, TXTexas | $238.63 | $73.46 |
| Dallas, TXTexas | $240.15 | $74.15 |
| Fort Worth, TXTexas | $238.32 | $73.98 |
| Galveston, TXTexas | $239.33 | $73.83 |
| Houston, TXTexas | $242.99 | $77.49 |
| Rest of TexasTexas | $231.03 | $72.86 |
| UtahUtah | $229.26 | $72.59 |
| VirginiaVirginia | $236.25 | $72.42 |
| Virgin Islands, VIUnited States Virgin Islands | $243.50 | $75.00 |
| VermontVermont | $236.26 | $71.26 |
| Rest of WashingtonWashington | $250.64 | $75.14 |
| King County, WAWashington | $286.06 | $81.55 |
| WisconsinWisconsin | $228.79 | $69.12 |
| West VirginiaWest Virginia | $219.16 | $74.33 |
| WyomingWyoming | $239.75 | $73.08 |
46611 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.
$211.12
$292.84
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 | $272.20 | 1 |
| AL | $214.54 | 1 |
| AR | $211.12 | 1 |
| AZ | $234.56 | 1 |
| CA | $257.58–$328.09 | 29 |
| CO | $252.85 | 1 |
| CT | $258.55 | 1 |
| DC | $278.78 | 1 |
| DE | $238.72 | 1 |
| FL | $236.38–$259.59 | 3 |
| GA | $221.99–$246.04 | 2 |
| GU | $265.03 | 1 |
| HI | $265.03 | 1 |
| IA | $221.11 | 1 |
| ID | $222.58 | 1 |
| IL | $228.51–$252.14 | 4 |
| IN | $224.01 | 1 |
| KS | $219.71 | 1 |
| KY | $219.57 | 1 |
| LA | $219.08–$231.05 | 2 |
| MA | $251.01–$279.82 | 2 |
| MD | $243.67–$278.78 | 3 |
| ME | $223.57–$237.29 | 2 |
| MI | $225.61–$239.34 | 2 |
| MN | $242.36 | 1 |
| MO | $214.77–$232.27 | 3 |
| MS | $213.00 | 1 |
| MT | $241.48 | 1 |
| NC | $226.19 | 1 |
| ND | $237.52 | 1 |
| NE | $222.52 | 1 |
| NH | $248.54 | 1 |
| NJ | $261.53–$275.40 | 2 |
| NM | $226.86 | 1 |
| NV | $240.57 | 1 |
| NY | $229.89–$286.29 | 5 |
| OH | $224.80 | 1 |
| OK | $219.41 | 1 |
| OR | $238.73–$261.81 | 2 |
| PA | $225.35–$251.43 | 2 |
| PR | $243.50 | 1 |
| RI | $247.92 | 1 |
| SC | $225.86 | 1 |
| SD | $237.05 | 1 |
| TN | $220.89 | 1 |
| TX | $223.70–$251.97 | 8 |
| UT | $229.26 | 1 |
| VA | $236.25–$278.78 | 2 |
| VI | $243.50 | 1 |
| VT | $236.26 | 1 |
| WA | $250.64–$286.06 | 2 |
| WI | $228.79 | 1 |
| WV | $219.16 | 1 |
| WY | $239.75 | 1 |
How the 46611 rate is calculated
Each of 46611’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 · 46611
RVUs × geographic indexes × conversion factor
Work1.27
1.27 RVUs× 1.000 GPCI
Practice expense5.76
5.76 RVUs× 1.000 GPCI
Malpractice0.20
0.20 RVUs× 1.000 GPCI
Adjusted RVUs
7.2300
Conversion factor
$33.4009
Medicare rate
$241.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Marin County, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,605
- Code
- 46611
- Physician work
- 1.27
- Practice expense
- 5.76
- Malpractice
- 0.20
GPCI2026.csv
25
- Locality
- Marin County, CA
- Physician work
- 1.095
- Practice expense
- 1.410
- Malpractice
- 0.459
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.27 | × 1.095 | 1.3906 |
| Practice expense | 5.76 | × 1.410 | 8.1216 |
| Malpractice | 0.20 | × 0.459 | 0.0918 |
| Total RVUs | 9.6040 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Marin County, CA$320.78
Office: (1.27 × 1.095 + 5.76 × 1.41 + 0.2 × 0.459) × $33.4009 = $320.78
Facility: (1.27 × 1.095 + 0.77 × 1.41 + 0.2 × 0.459) × $33.4009 = $85.78
Payment rules and modifiers for 46611
The CMS indicators that decide how 46611 is paid alongside other services.
CMS payment indicators · 46611
Anoscopy, snare lesion removal
| 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
46611 without 51 · national office
$241.49
Anoscopy, snare lesion removal
46611-51 · Second procedure: 50%
$120.75
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 46611 has changed in Marin County, CA
46611 · Office / nonfacility
$320.78
Effective 2026-10-01
The base rate is $41.42 higher than on 2025-10-01, moving from $279.36 to $320.78 (14.8%).
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
$279.36changed to$320.78
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.30 changed to 1.27
- Practice expense RVU 5.02 changed to 5.76
- Malpractice RVU 0.21 changed to 0.20
- Work GPCI 1.088 changed to 1.095
- Practice expense GPCI 1.419 changed to 1.410
- Malpractice GPCI 0.470 changed to 0.459
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$295.36changed to$279.36
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 5.19 changed to 5.02
- Malpractice RVU 0.20 changed to 0.21
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$290.54changed to$295.36
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$295.25changed to$290.54
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 5.25 changed to 5.19
- Malpractice RVU 0.19 changed to 0.20
- Work GPCI 1.082 changed to 1.088
- Practice expense GPCI 1.374 changed to 1.419
- Malpractice GPCI 0.487 changed to 0.470
January 1, 2023
RVU23A
$302.13changed to$295.25
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 5.44 changed to 5.25
- Malpractice RVU 0.20 changed to 0.19
- Work GPCI 1.077 changed to 1.082
- Practice expense GPCI 1.329 changed to 1.374
- Malpractice GPCI 0.504 changed to 0.487
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$293.91changed to$302.13
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 5.29 changed to 5.44
- Malpractice RVU 0.19 changed to 0.20
- Work GPCI 1.071 changed to 1.077
- Practice expense GPCI 1.311 changed to 1.329
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$254.52changed to$293.91
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 4.29 changed to 5.29
- Work GPCI 1.068 changed to 1.071
- Practice expense GPCI 1.299 changed to 1.311
- Malpractice GPCI 0.481 changed to 0.504
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$235.75changed to$254.52
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 3.92 changed to 4.29
- Malpractice RVU 0.21 changed to 0.19
- Work GPCI 1.065 changed to 1.068
- Practice expense GPCI 1.291 changed to 1.299
- Malpractice GPCI 0.458 changed to 0.481
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$218.62changed to$235.75
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.59 changed to 3.92
- Malpractice RVU 0.22 changed to 0.21
- Work GPCI 1.062 changed to 1.065
- Practice expense GPCI 1.279 changed to 1.291
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$213.23changed to$218.62
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.51 changed to 3.59
- Work GPCI 1.058 changed to 1.062
- Practice expense GPCI 1.271 changed to 1.279
- Malpractice GPCI 0.477 changed to 0.458
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$213.23
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 | $320.78 | $85.78 | RVU26D |
| 2026-07-01 | $320.78 | $85.78 | RVU26C |
| 2026-04-01 | $320.78 | $85.78 | RVU26B |
| 2026-01-01 | $320.78 | $85.78 | RVU26A |
| 2025-10-01 | $279.36 | $90.71 | RVU25D |
| 2025-07-01 | $279.36 | $90.71 | RVU25C |
| 2025-04-01 | $279.36 | $90.71 | RVU25B |
| 2025-01-01 | $279.36 | $90.71 | RVU25A |
| 2024-10-01 | $295.36 | $93.19 | RVU24D |
| 2024-07-01 | $295.36 | $93.19 | RVU24C |
| 2024-04-01 | $295.36 | $93.19 | RVU24B |
| 2024-03-09 | $295.36 | $93.19 | RVU24AR |
| 2024-01-01 | $290.54 | $91.67 | RVU24A |
| 2023-10-01 | $295.25 | $92.24 | RVU23D |
| 2023-07-01 | $295.25 | $92.24 | RVU23C |
| 2023-04-01 | $295.25 | $92.24 | RVU23B |
| 2023-01-01 | $295.25 | $92.24 | RVU23A |
| 2022-10-01 | $302.13 | $91.95 | RVU22D |
| 2022-07-01 | $302.13 | $91.95 | RVU22C |
| 2022-04-01 | $302.13 | $91.95 | RVU22B |
| 2022-01-01 | $302.13 | $91.95 | RVU22A |
| 2021-10-01 | $293.91 | $90.81 | RVU21D |
| 2021-07-01 | $293.91 | $90.81 | RVU21C |
| 2021-04-01 | $293.91 | $90.81 | RVU21B |
| 2021-01-01 | $293.91 | $90.81 | RVU21A |
| 2020-10-01 | $254.52 | $91.85 | RVU20D |
| 2020-07-01 | $254.52 | $91.85 | RVU20C |
| 2020-04-01 | $254.52 | $91.85 | RVU20B |
| 2020-01-01 | $254.52 | $91.85 | RVU20A |
| 2019-10-01 | $235.75 | $91.51 | RVU19D |
| 2019-07-01 | $235.75 | $91.51 | RVU19C |
| 2019-04-01 | $235.75 | $91.51 | RVU19B |
| 2019-01-01 | $235.75 | $91.51 | RVU19A |
| 2018-10-01 | $218.62 | $92.00 | RVU18D |
| 2018-07-01 | $218.62 | $92.00 | RVU18C |
| 2018-04-01 | $218.62 | $92.00 | RVU18B |
| 2018-01-01 | $218.62 | $92.00 | RVU18AR1 |
| 2017-10-01 | $213.23 | $91.44 | RVU17D |
| 2017-07-01 | $213.23 | $91.44 | RVU17C |
| 2017-04-01 | $213.23 | $91.44 | RVU17B |
| 2017-01-01 | $213.23 | $91.44 | 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 Marin County, CA rate applies
Marin County, CA is a Medicare payment area, not a city. Our Census mapping connects it to 31 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Alto
- Belvedere
- Black Point-Green Point
- Bolinas
- Corte Madera
- Dillon Beach
- Fairfax
- Inverness
46611 billing questions
When should this code be selected instead of diagnostic anoscopy?
Use this code when the clinician removes a tumor, polyp, or other lesion with a snare. Diagnostic-only examination without snare removal is reported with 46600.
Can diagnostic anoscopy be billed separately on the same encounter?
The examination performed to locate and treat the lesion is part of the snare-removal service, rather than a separate diagnostic anoscopy.
How does this differ from anoscopic lesion removal with cautery?
This code identifies snare technique. Code 46612 is for lesion removal using hot biopsy forceps or bipolar cautery.
Should modifier 50 be used for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 does not describe this anorectal service.
What staffing and same-day care rules affect payment?
The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
What happens when related endoscopies are performed during the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The record should identify the services performed and the lesion-removal technique.
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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