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CPT code 46611: Anoscopy, snare lesion removal2026 Medicare rate & RVUs in Hawaii, Guam, HI

Anoscopy with snare excision removes a tumor, polyp, or other lesion from the anal canal when the clinician uses snare technique.

CMS RVU26DEffective Oct 1, 2026One payment locality187 Medicare services in 2024

In Hawaii, Guam, HI, Medicare pays $265.03 for 46611 in the office and $75.53 when it’s performed in a hospital or facility.

$265.03Office (non-facility)
$75.53Hospital or facility
+9.7%vs the national office rate ($241.49)

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.

We’ll open 46611 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Hawaii, Guam, HI
  2. What 46611 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 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 Hawaii, Guam, HI 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. Hawaii, Guam, HI pays $265.03. The RVUs are the same everywhere; the geographic indexes change the dollars.

46611 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$265.03
  2. Los Angeles, CA · California$276.19+$11.16
  3. Washington, DC area · District of Columbia$278.78+$13.75
  4. Miami, FL · Florida$259.59−$5.44
  5. Chicago, IL · Illinois$251.40−$13.63
  6. Manhattan, NY · New York$279.28+$14.25
  7. Alaska · Alaska$272.20+$7.17

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

Every other payment area

46611 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$214.54$68.70
ArkansasArkansas$211.12$67.95
ArizonaArizona$234.56$73.06
Bakersfield, CACalifornia$258.15$75.48
Chico, CACalifornia$257.58$74.91
El Centro, CACalifornia$257.61$74.94
Fresno, CACalifornia$257.58$74.91
Hanford, CACalifornia$257.58$74.91

46611 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.

$211.12

$292.84

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
46611 office rate range by state
State / territoryOffice rate rangeLocalities
AK$272.201
AL$214.541
AR$211.121
AZ$234.561
CA$257.58–$328.0929
CO$252.851
CT$258.551
DC$278.781
DE$238.721
FL$236.38–$259.593
GA$221.99–$246.042
GU$265.031
HI$265.031
IA$221.111
ID$222.581
IL$228.51–$252.144
IN$224.011
KS$219.711
KY$219.571
LA$219.08–$231.052
MA$251.01–$279.822
MD$243.67–$278.783
ME$223.57–$237.292
MI$225.61–$239.342
MN$242.361
MO$214.77–$232.273
MS$213.001
MT$241.481
NC$226.191
ND$237.521
NE$222.521
NH$248.541
NJ$261.53–$275.402
NM$226.861
NV$240.571
NY$229.89–$286.295
OH$224.801
OK$219.411
OR$238.73–$261.812
PA$225.35–$251.432
PR$243.501
RI$247.921
SC$225.861
SD$237.051
TN$220.891
TX$223.70–$251.978
UT$229.261
VA$236.25–$278.782
VI$243.501
VT$236.261
WA$250.64–$286.062
WI$228.791
WV$219.161
WY$239.751

See 46611 in every payment locality

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

Office or facility?

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 Hawaii, Guam, HI 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

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 46611 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work1.27× 1.0001.2700
Practice expense5.76× 1.1376.5491
Malpractice0.20× 0.5790.1158
Total RVUs7.9349
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$265.03

Office: (1.27 × 1 + 5.76 × 1.137 + 0.2 × 0.579) × $33.4009 = $265.03

Facility: (1.27 × 1 + 0.77 × 1.137 + 0.2 × 0.579) × $33.4009 = $75.53

Open 46611 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 46611

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 46611
CodeHow it relatesOffice range, Hawaii, Guam, HI
Used instead
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic-only anoscopy without snare removal is reported with this code.$142.63
46610Anoscopy, hot forceps or bipolar cauteryAnoscopic removal of a foreign body rather than a tumor, polyp, or lesion.$337.86
46612Anoscopy, lesion removal by excisionAnoscopic lesion removal using hot biopsy forceps or bipolar cautery.$403.04
46614Anoscopy, bleeding controlAnoscopy to control bleeding rather than to remove a lesion by snare.$201.03
46615Anoscopy, lesion ablationAnoscopic lesion ablation rather than snare removal.$207.39
46606Anoscopy biopsy, biopsy performedAnoscopic biopsy when tissue sampling, rather than snare excision, is performed.$339.93
Same family
46604Anoscopy, with dilationAnoscopy with dilation; a different therapeutic service in the anoscopy code family.$777.81

How 46611 has changed in Hawaii, Guam, HI

46611 · Office / nonfacility

$265.03

Effective 2026-10-01

The base rate is $32.59 higher than on 2025-10-01, moving from $232.44 to $265.03 (14.0%).

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

    $232.44changed to$265.03

    • 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
    • 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

    $245.51changed to$232.44

    • 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.

  3. March 9, 2024

    RVU24AR

    $241.51changed to$245.51

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $252.05changed to$241.51

    • 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 1.003 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

    $265.29changed to$252.05

    • 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 1.010 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

    $261.27changed to$265.29

    • 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

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $228.73changed to$261.27

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.29 changed to 5.29
    • 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

    $213.44changed to$228.73

    • 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 1.001 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

    $199.82changed to$213.44

    • 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

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $196.98changed to$199.82

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.51 changed to 3.59
    • 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

    $196.75changed to$196.98

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.49 changed to 3.51
    • 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

    $196.63changed to$196.75

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.47 changed to 3.49

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $195.65changed to$196.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $195.39changed to$195.65

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.46 changed to 3.47
    • 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

    $200.48changed to$195.39

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.84 changed to 3.46
    • 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$200.48

  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$265.03$75.53RVU26D
2026-07-01$265.03$75.53RVU26C
2026-04-01$265.03$75.53RVU26B
2026-01-01$265.03$75.53RVU26A
2025-10-01$232.44$79.68RVU25D
2025-07-01$232.44$79.68RVU25C
2025-04-01$232.44$79.68RVU25B
2025-01-01$232.44$79.68RVU25A
2024-10-01$245.51$81.81RVU24D
2024-07-01$245.51$81.81RVU24C
2024-04-01$245.51$81.81RVU24B
2024-03-09$245.51$81.81RVU24AR
2024-01-01$241.51$80.48RVU24A
2023-10-01$252.05$82.73RVU23D
2023-07-01$252.05$82.73RVU23C
2023-04-01$252.05$82.73RVU23B
2023-01-01$252.05$82.73RVU23A
2022-10-01$265.29$84.52RVU22D
2022-07-01$265.29$84.52RVU22C
2022-04-01$265.29$84.52RVU22B
2022-01-01$265.29$84.52RVU22A
2021-10-01$261.27$84.19RVU21D
2021-07-01$261.27$84.19RVU21C
2021-04-01$261.27$84.19RVU21B
2021-01-01$261.27$84.19RVU21A
2020-10-01$228.73$85.47RVU20D
2020-07-01$228.73$85.47RVU20C
2020-04-01$228.73$85.47RVU20B
2020-01-01$228.73$85.47RVU20A
2019-10-01$213.44$85.41RVU19D
2019-07-01$213.44$85.41RVU19C
2019-04-01$213.44$85.41RVU19B
2019-01-01$213.44$85.41RVU19A
2018-10-01$199.82$86.36RVU18D
2018-07-01$199.82$86.36RVU18C
2018-04-01$199.82$86.36RVU18B
2018-01-01$199.82$86.36RVU18AR1
2017-10-01$196.98$86.40RVU17D
2017-07-01$196.98$86.40RVU17C
2017-04-01$196.98$86.40RVU17B
2017-01-01$196.98$86.40RVU17A
2016-10-01$196.75$86.08RVU16D
2016-07-01$196.75$86.08RVU16C
2016-04-01$196.75$86.08RVU16B
2016-01-01$196.75$86.08RVU16A
2015-10-01$196.63$86.81RVU15D
2015-07-01$196.63$86.81RVU15C
2015-04-01$195.65$86.38RVU15B
2015-01-01$195.65$86.38RVU15A
2014-10-01$195.39$86.70RVU14D
2014-07-01$195.39$86.70RVU14C
2014-04-01$195.39$86.70RVU14B
2014-01-01$195.39$86.70RVU14A
2013-10-01$200.48$85.83RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46611 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

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
RVUs for 46611PPRRVU2026_Oct_nonQPP.csv, line 5,605 (RVU26D)
Geographic factors for Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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