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CPT code 46612: Anoscopy, lesion removal by excision2026 Medicare rate & RVUs in Puerto Rico

Reports anoscopic excision of an anal canal lesion, such as a polyp or tumor, when the lesion is removed using an excisional technique.

CMS RVU26DEffective Oct 1, 2026One payment locality89 Medicare services in 2024

In Puerto Rico, Medicare pays $369.90 for 46612 in the office and $90.64 when it’s performed in a hospital or facility.

$369.90Office (non-facility)
$90.64Hospital or facility
+0.9%vs the national office rate ($366.74)

Check a contract rate as a % of Medicare · 46612 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 46612 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 46612 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 46612 covers

The clinician uses an anoscope to view the anal canal and surgically excise a tumor, polyp, or other lesion. Colorectal and general surgeons commonly perform this procedure in an office, outpatient department, or operating room. The removed tissue may be submitted for pathologic examination. This code distinguishes excision from lesion removal using hot biopsy forceps or bipolar cautery, snare removal, or ablation.

Select the code based on the technique documented, not merely the presence or number of lesions. The procedure note should identify the lesion site and extent, describe excision as the removal method, and record the specimens obtained. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery for this code; co-surgery 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 46612

Across 109 of 109 payment localities, the office rate for 46612 runs from $317.43 in Arkansas to $500.85 in San Benito County, CA. Puerto Rico pays $369.90. The RVUs are the same everywhere; the geographic indexes change the dollars.

46612 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$369.90
  2. Los Angeles, CA · California$420.17+$50.27
  3. Washington, DC area · District of Columbia$425.13+$55.23
  4. Miami, FL · Florida$399.16+$29.26
  5. Chicago, IL · Illinois$385.48+$15.58
  6. Manhattan, NY · New York$426.90+$57.00
  7. Alaska · Alaska$405.10+$35.20

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

Every other payment area

46612 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$322.97$81.27
ArkansasArkansas$317.43$80.15
ArizonaArizona$355.41$87.75
Bakersfield, CACalifornia$391.85$89.11
Chico, CACalifornia$390.80$88.06
El Centro, CACalifornia$390.87$88.12
Fresno, CACalifornia$390.80$88.06
Hanford, CACalifornia$390.80$88.06

46612 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.

$317.43

$445.83

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

View every state and territory as a table
46612 office rate range by state
State / territoryOffice rate rangeLocalities
AK$405.101
AL$322.971
AR$317.431
AZ$355.411
CA$390.80–$500.8529
CO$383.991
CT$393.931
DC$425.131
DE$362.011
FL$359.88–$399.163
GA$336.31–$374.392
GU$403.041
HI$403.041
IA$332.971
ID$335.481
IL$347.55–$385.484
IN$337.781
KS$331.011
KY$331.791
LA$331.13–$350.522
MA$381.04–$426.472
MD$369.82–$425.133
ME$337.42–$359.192
MI$341.89–$365.002
MN$366.411
MO$324.32–$352.133
MS$320.951
MT$366.721
NC$341.611
ND$359.001
NE$335.161
NH$377.621
NJ$398.01–$419.492
NM$344.051
NV$364.871
NY$347.63–$438.665
OH$340.321
OK$331.211
OR$361.65–$398.042
PA$341.02–$382.642
PR$369.901
RI$376.321
SC$341.611
SD$358.091
TN$332.961
TX$338.37–$383.048
UT$347.121
VA$357.73–$425.132
VI$369.901
VT$357.261
WA$380.42–$436.022
WI$344.921
WV$332.411
WY$363.361

See 46612 in every payment locality

How the 46612 rate is calculated

Each of 46612’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 · 46612

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.46

1.46 RVUs× 1.000 GPCI

Practice expense9.13

9.13 RVUs× 1.000 GPCI

Malpractice0.39

0.39 RVUs× 1.000 GPCI

Adjusted RVUs

10.9800

Conversion factor

$33.4009

Medicare rate

$366.74

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

5,606

Code
46612
Physician work
1.46
Practice expense
9.13
Malpractice
0.39

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 46612 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.46× 1.0001.4600
Practice expense9.13× 1.0119.2304
Malpractice0.39× 0.9850.3841
Total RVUs11.0746
Conversion factor× 33.4009

Office rate, Puerto Rico$369.90

Office: (1.46 × 1 + 9.13 × 1.011 + 0.39 × 0.985) × $33.4009 = $369.90

Facility: (1.46 × 1 + 0.86 × 1.011 + 0.39 × 0.985) × $33.4009 = $90.64

Open 46612 in the RVU calculator

Payment rules and modifiers for 46612

The CMS indicators that decide how 46612 is paid alongside other services.

CMS payment indicators · 46612

Anoscopy, lesion removal by excision

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

46612 without 51 · national office

$366.74

Anoscopy, lesion removal by excision

46612-51 · Second procedure: 50%

$183.37

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 46612

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

Codes related to 46612
CodeHow it relatesOffice range, Puerto Rico
Same family
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with lesion removal using hot biopsy forceps or bipolar cautery.$308.66
46611Anoscopy, snare lesion removalAnoscopy with lesion removal by snare technique.$243.50
46615Anoscopy, lesion ablationAnoscopy with lesion ablation rather than excision.$193.11
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy, rather than excisional lesion removal.$309.73
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without the lesion-removal service.$130.08

How 46612 has changed in Puerto Rico

46612 · Office / nonfacility

$369.90

Effective 2026-10-01

The base rate is $55.57 higher than on 2025-10-01, moving from $314.33 to $369.90 (17.7%).

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

    $314.33changed to$369.90

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.50 changed to 1.46
    • Practice expense RVU 7.78 changed to 9.13
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $331.85changed to$314.33

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.03 changed to 7.78

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $326.43changed to$331.85

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $344.97changed to$326.43

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.25 changed to 8.03
    • Malpractice RVU 0.37 changed to 0.39
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $342.94changed to$344.97

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $363.82changed to$342.94

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.56 changed to 8.25
    • Malpractice RVU 0.39 changed to 0.37
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $362.98changed to$363.82

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.47 changed to 8.56
    • Malpractice RVU 0.37 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $323.07changed to$362.98

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.03 changed to 8.47
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $303.88changed to$323.07

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 6.52 changed to 7.03
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. July 1, 2019

    RVU19C

    $303.52changed to$303.88

    • Malpractice RVU 0.36 changed to 0.37

    Held through RVU19D.

  11. January 1, 2019

    RVU19A

    $286.51changed to$303.52

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 6.06 changed to 6.52

    Held through RVU19B.

  12. January 1, 2018

    RVU18AR1

    $223.57changed to$286.51

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.30 changed to 6.06
    • Malpractice RVU 0.30 changed to 0.36
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  13. January 1, 2017

    RVU17A

    $196.40changed to$223.57

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.52 changed to 5.30
    • Malpractice RVU 0.32 changed to 0.30
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  14. January 1, 2016

    RVU16A

    $209.44changed to$196.40

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.99 changed to 5.52
    • Malpractice RVU 0.36 changed to 0.32

    Held through RVU16B, RVU16C, RVU16D.

  15. July 1, 2015

    RVU15C

    $208.39changed to$209.44

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  16. January 1, 2015

    RVU15A

    $203.90changed to$208.39

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.94 changed to 5.99
    • Malpractice RVU 0.30 changed to 0.36
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  17. January 1, 2014

    RVU14A

    $209.83changed to$203.90

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.77 changed to 5.94
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  18. January 1, 2013

    RVU13AR

    Earliest loaded release: $209.83

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$369.90$90.64RVU26D
2026-07-01$369.90$90.64RVU26C
2026-04-01$369.90$90.64RVU26B
2026-01-01$369.90$90.64RVU26A
2025-10-01$314.33$93.48RVU25D
2025-07-01$314.33$93.48RVU25C
2025-04-01$314.33$93.48RVU25B
2025-01-01$314.33$93.48RVU25A
2024-10-01$331.85$95.19RVU24D
2024-07-01$331.85$95.19RVU24C
2024-04-01$331.85$95.19RVU24B
2024-03-09$331.85$95.19RVU24AR
2024-01-01$326.43$93.64RVU24A
2023-10-01$344.97$95.62RVU23D
2023-07-01$342.94$95.56RVU23C
2023-04-01$342.94$95.56RVU23B
2023-01-01$342.94$95.56RVU23A
2022-10-01$363.82$98.01RVU22D
2022-07-01$363.82$98.01RVU22C
2022-04-01$363.82$98.01RVU22B
2022-01-01$363.82$98.01RVU22A
2021-10-01$362.98$97.78RVU21D
2021-07-01$362.98$97.78RVU21C
2021-04-01$362.98$97.78RVU21B
2021-01-01$362.98$97.78RVU21A
2020-10-01$323.07$99.70RVU20D
2020-07-01$323.07$99.70RVU20C
2020-04-01$323.07$99.70RVU20B
2020-01-01$323.07$99.70RVU20A
2019-10-01$303.88$99.20RVU19D
2019-07-01$303.88$99.20RVU19C
2019-04-01$303.52$98.84RVU19B
2019-01-01$303.52$98.84RVU19A
2018-10-01$286.51$99.09RVU18D
2018-07-01$286.51$99.09RVU18C
2018-04-01$286.51$99.09RVU18B
2018-01-01$286.51$99.09RVU18AR1
2017-10-01$223.57$87.17RVU17D
2017-07-01$223.57$87.17RVU17C
2017-04-01$223.57$87.17RVU17B
2017-01-01$223.57$87.17RVU17A
2016-10-01$196.40$79.28RVU16D
2016-07-01$196.40$79.28RVU16C
2016-04-01$196.40$79.28RVU16B
2016-01-01$196.40$79.28RVU16A
2015-10-01$209.44$80.49RVU15D
2015-07-01$209.44$80.49RVU15C
2015-04-01$208.39$80.09RVU15B
2015-01-01$208.39$80.09RVU15A
2014-10-01$203.90$78.96RVU14D
2014-07-01$203.90$78.96RVU14C
2014-04-01$203.90$78.96RVU14B
2014-01-01$203.90$78.96RVU14A
2013-10-01$209.83$76.73RVU13D
2013-07-01$209.83$76.73RVU13C
2013-04-01$209.83$76.73RVU13B
2013-01-01$209.83$76.73RVU13AR

Price 46612 for an earlier date of service

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

Browse all communities in Puerto Rico

46612 billing questions

How is this code different from snare removal?

Use this code when the lesion is removed by excision. Anoscopy with snare removal is reported with 46611.

When would hot biopsy forceps or bipolar cautery apply instead?

Code 46610 describes lesion removal using hot biopsy forceps or bipolar cautery. Choose based on the documented removal technique.

Can diagnostic anoscopy be reported separately with the excision?

The diagnostic viewing is part of the anoscopic excision service. Endoscopy-family pricing applies when related endoscopies are performed together.

Is modifier 50 appropriate for lesions on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

What does the 0-day global period mean?

Same-day preoperative and postoperative care is included. The global period for this procedure is 0 days.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgery 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
RVUs for 46612PPRRVU2026_Oct_nonQPP.csv, line 5,606 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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