CPT code 46614: Anoscopy, bleeding control2026 Medicare rate & RVUs
Anoscopy with hemostasis is reported when a clinician uses an anoscope to identify and control active bleeding in the anal canal or lower rectum.
Medicare pays $183.37 for 46614 nationally in the office and $61.46 in a hospital or facility. Local office rates run $160.29–$248.71.
Medicare rate · 46614
Anoscopy, bleeding control
- Work RVUs
- 0.98
- Total RVUs
- 5.49
- Global days
- 000
National rate · 2026
$183.37
Office setting, before claim adjustments.
See every locality for 46614 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 46614 covers
This procedure combines examination through an anoscope with treatment to stop bleeding. It may be performed by a colorectal or general surgeon, or another clinician experienced in anorectal procedures, in an office or facility setting. The service is appropriate when bleeding requires active control during the anoscopic procedure, rather than inspection alone or tissue sampling alone.
Report the code when the record identifies the bleeding site and documents the hemostatic work performed. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed in the same session, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. An assistant at surgery is not paid under the statutory restriction; 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.
Where 46614 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$160.29 to $248.71
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $162.89 | $56.22 |
| Alaska | $206.78 | $76.94 |
| Arizona | $178.10 | $59.96 |
| Arkansas | $160.29 | $55.57 |
| Atlanta, GA | $186.87 | $63.00 |
| Austin, TX | $191.25 | $62.27 |
| Bakersfield, CA | $195.85 | $62.23 |
| Baltimore area, MD | $195.77 | $64.95 |
| Beaumont, TX | $169.92 | $58.97 |
| Brazoria, TX | $181.15 | $60.33 |
| Chicago, IL | $191.25 | $68.72 |
| Chico, CA | $195.40 | $61.78 |
| Colorado | $191.89 | $62.18 |
| Connecticut | $196.34 | $65.03 |
| Dallas, TX | $182.33 | $60.90 |
| Delaware | $181.25 | $60.80 |
| Detroit, MI | $181.95 | $64.31 |
| East St. Louis, IL | $177.17 | $65.01 |
| El Centro, CA | $195.42 | $61.81 |
| Fort Lauderdale, FL | $189.58 | $66.08 |
| Fort Worth, TX | $180.94 | $60.74 |
| Fresno, CA | $195.40 | $61.78 |
| Galveston, TX | $181.70 | $60.64 |
| Hanford, CA | $195.40 | $61.78 |
| Hawaii, Guam, HI | $201.03 | $62.41 |
| Houston, TX | $184.63 | $63.57 |
| Idaho | $168.93 | $56.77 |
| Indiana | $170.02 | $57.00 |
| Iowa | $167.80 | $56.25 |
| Kansas | $166.77 | $56.56 |
| Kentucky | $166.79 | $58.41 |
| King County, WA | $217.01 | $67.42 |
| Los Angeles, CA | $209.51 | $65.28 |
| Madera, CA | $195.40 | $61.78 |
| Manhattan, NY | $212.14 | $70.47 |
| Marin County, CA | $243.16 | $71.26 |
| Merced, CA | $195.40 | $61.78 |
| Metropolitan Boston, MA | $212.31 | $66.75 |
| Metropolitan Kansas City, MO | $174.39 | $59.91 |
| Metropolitan Philadelphia, PA | $190.95 | $64.04 |
| Metropolitan St. Louis, MO | $176.41 | $60.35 |
| Miami, FL | $197.50 | $70.59 |
| Minnesota | $183.82 | $58.37 |
| Mississippi | $161.78 | $56.81 |
| Modesto, CA | $195.40 | $61.78 |
| Montana | $183.36 | $61.45 |
| Napa, CA | $229.01 | $68.33 |
| Nebraska | $168.86 | $56.33 |
| Nevada | $182.62 | $60.59 |
| New Hampshire | $188.66 | $61.75 |
| New Mexico | $172.39 | $60.59 |
| New Orleans, LA | $175.53 | $60.81 |
| North Carolina | $171.71 | $57.96 |
| North Dakota | $180.20 | $58.28 |
| Northern New Jersey | $209.04 | $67.62 |
| NYC suburbs and Long Island, NY | $217.51 | $72.55 |
| Ohio | $170.77 | $59.47 |
| Oklahoma | $166.63 | $57.76 |
| Oxnard, CA | $208.72 | $64.61 |
| Portland, OR | $198.65 | $63.21 |
| Poughkeepsie and northern NYC suburbs, NY | $199.77 | $66.27 |
| Puerto Rico | $184.89 | $61.63 |
| Queens, NY | $214.27 | $70.17 |
| Redding, CA | $195.40 | $61.78 |
| Rest of California | $195.40 | $61.78 |
| Rest of Florida | $179.67 | $63.12 |
| Rest of Georgia | $168.71 | $59.96 |
| Rest of Illinois | $173.74 | $62.43 |
| Rest of Louisiana | $166.44 | $58.54 |
| Rest of Maine | $169.73 | $57.57 |
| Rest of Maryland | $185.00 | $61.63 |
| Rest of Massachusetts | $190.51 | $62.14 |
| Rest of Michigan | $171.42 | $60.11 |
| Rest of Missouri | $163.18 | $58.09 |
| Rest of New Jersey | $198.57 | $65.44 |
| Rest of New York | $174.52 | $58.70 |
| Rest of Oregon | $181.20 | $59.78 |
| Rest of Pennsylvania | $171.16 | $59.25 |
| Rest of Texas | $175.44 | $59.75 |
| Rest of Washington | $190.22 | $61.85 |
| Rhode Island | $188.21 | $62.27 |
| Riverside, CA | $197.12 | $63.51 |
| Sacramento, CA | $205.75 | $63.97 |
| Salinas, CA | $205.01 | $63.71 |
| San Benito County, CA | $248.71 | $72.91 |
| San Diego, CA | $210.38 | $64.57 |
| San Francisco, CA | $242.98 | $71.08 |
| San Luis Obispo, CA | $201.64 | $62.78 |
| Santa Clara County, CA | $247.97 | $72.17 |
| Santa Cruz, CA | $212.82 | $64.69 |
| Santa Maria, CA | $205.93 | $63.78 |
| Santa Rosa, CA | $215.00 | $65.29 |
| South Carolina | $171.53 | $58.88 |
| South Dakota | $179.82 | $57.91 |
| Southern Maine, ME | $180.09 | $59.28 |
| Stockton, CA | $195.40 | $61.78 |
| Suburban Chicago, IL | $191.65 | $66.44 |
| Tennessee | $167.67 | $56.86 |
| Utah | $174.11 | $59.51 |
| Vallejo, CA | $228.75 | $68.06 |
| Vermont | $179.28 | $58.58 |
| Virgin Islands, VI | $184.89 | $61.63 |
| Virginia | $179.33 | $59.49 |
| Visalia, CA | $195.40 | $61.78 |
| Washington, DC area | $211.60 | $67.99 |
| West Virginia | $166.64 | $60.70 |
| Wisconsin | $173.57 | $56.78 |
| Wyoming | $181.98 | $60.07 |
| Yuba City, CA | $195.40 | $61.78 |
46614 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.
$160.29
$222.06
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 | $206.78 | 1 |
| AL | $162.89 | 1 |
| AR | $160.29 | 1 |
| AZ | $178.10 | 1 |
| CA | $195.40–$248.71 | 29 |
| CO | $191.89 | 1 |
| CT | $196.34 | 1 |
| DC | $211.60 | 1 |
| DE | $181.25 | 1 |
| FL | $179.67–$197.50 | 3 |
| GA | $168.71–$186.87 | 2 |
| GU | $201.03 | 1 |
| HI | $201.03 | 1 |
| IA | $167.80 | 1 |
| ID | $168.93 | 1 |
| IL | $173.74–$191.65 | 4 |
| IN | $170.02 | 1 |
| KS | $166.77 | 1 |
| KY | $166.79 | 1 |
| LA | $166.44–$175.53 | 2 |
| MA | $190.51–$212.31 | 2 |
| MD | $185.00–$211.60 | 3 |
| ME | $169.73–$180.09 | 2 |
| MI | $171.42–$181.95 | 2 |
| MN | $183.82 | 1 |
| MO | $163.18–$176.41 | 3 |
| MS | $161.78 | 1 |
| MT | $183.36 | 1 |
| NC | $171.71 | 1 |
| ND | $180.20 | 1 |
| NE | $168.86 | 1 |
| NH | $188.66 | 1 |
| NJ | $198.57–$209.04 | 2 |
| NM | $172.39 | 1 |
| NV | $182.62 | 1 |
| NY | $174.52–$217.51 | 5 |
| OH | $170.77 | 1 |
| OK | $166.63 | 1 |
| OR | $181.20–$198.65 | 2 |
| PA | $171.16–$190.95 | 2 |
| PR | $184.89 | 1 |
| RI | $188.21 | 1 |
| SC | $171.53 | 1 |
| SD | $179.82 | 1 |
| TN | $167.67 | 1 |
| TX | $169.92–$191.25 | 8 |
| UT | $174.11 | 1 |
| VA | $179.33–$211.60 | 2 |
| VI | $184.89 | 1 |
| VT | $179.28 | 1 |
| WA | $190.22–$217.01 | 2 |
| WI | $173.57 | 1 |
| WV | $166.64 | 1 |
| WY | $181.98 | 1 |
How the 46614 rate is calculated
Each of 46614’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 · 46614
RVUs × geographic indexes × conversion factor
Work0.98
0.98 RVUs× 1.000 GPCI
Practice expense4.35
4.35 RVUs× 1.000 GPCI
Malpractice0.16
0.16 RVUs× 1.000 GPCI
Adjusted RVUs
5.4900
Conversion factor
$33.4009
Medicare rate
$183.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46614
The CMS indicators that decide how 46614 is paid alongside other services.
CMS payment indicators · 46614
Anoscopy, bleeding control
| 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
46614 without 51 · national office
$183.37
Anoscopy, bleeding control
46614-51 · Second procedure: 50%
$91.69
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%).
46614 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46600Diagnostic anoscopyStandard visualization, optional washing
- 46600 represents diagnostic anoscopy. Choose 46614 when the procedure includes active work to control bleeding.
- 46606Anoscopy biopsyBiopsy performed
- 46606 is for anoscopy with biopsy. Use 46614 for hemostasis; biopsy alone does not make the service bleeding control.
- 46610AnoscopyHot forceps or bipolar cautery
- 46610 describes removal of a single lesion through anoscopy. 46614 is selected for control of bleeding, not lesion removal as the service.
- 46615AnoscopyLesion ablation
- 46615 is for anoscopic ablation of lesion tissue. 46614 is for hemostasis when control of bleeding is the procedure performed.
46614 billing questions
When should this be reported instead of diagnostic anoscopy?
Use this code when the anoscopic service includes active treatment to control bleeding. Diagnostic inspection without hemostasis is represented by 46600.
Can diagnostic anoscopy be billed separately with bleeding control?
The anoscopy is part of the bleeding-control service. Document the findings and hemostatic work rather than separately reporting a diagnostic examination for the same procedure.
How should related endoscopies performed in the same session be priced?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The record should identify each service performed during the session.
Should modifier 50 be appended?
No. The descriptor and anatomy make bilateral reporting with modifier 50 inappropriate.
Can an assistant or co-surgeon be billed?
An assistant at surgery is not paid under the statutory restriction. Co-surgeons and team surgery are not permitted for this service.
What documentation supports reporting this code?
Document the bleeding source or location, the anoscopic findings, and the method or work used to achieve hemostasis.
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
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