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CPT code 46614: Anoscopy, bleeding control2026 Medicare rate & RVUs in Iowa

Anoscopy with hemostasis is reported when a clinician uses an anoscope to identify and control active bleeding in the anal canal or lower rectum.

CMS RVU26DEffective Oct 1, 2026One payment locality853 Medicare services in 2024

In Iowa, Medicare pays $167.80 for 46614 in the office and $56.25 when it’s performed in a hospital or facility.

$167.80Office (non-facility)
$56.25Hospital or facility
−8.5%vs the national office rate ($183.37)

Check a contract rate as a % of Medicare · 46614 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 46614 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 46614 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 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.

How Iowa compares for 46614

Across 109 of 109 payment localities, the office rate for 46614 runs from $160.29 in Arkansas to $248.71 in San Benito County, CA. Iowa pays $167.80. The RVUs are the same everywhere; the geographic indexes change the dollars.

46614 in Iowa vs other payment areas
  1. Iowa · this page$167.80
  2. Los Angeles, CA · California$209.51+$41.71
  3. Washington, DC area · District of Columbia$211.60+$43.80
  4. Miami, FL · Florida$197.50+$29.70
  5. Chicago, IL · Illinois$191.25+$23.45
  6. Manhattan, NY · New York$212.14+$44.34
  7. Alaska · Alaska$206.78+$38.98

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

Every other payment area

46614 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$162.89$56.22
ArkansasArkansas$160.29$55.57
ArizonaArizona$178.10$59.96
Bakersfield, CACalifornia$195.85$62.23
Chico, CACalifornia$195.40$61.78
El Centro, CACalifornia$195.42$61.81
Fresno, CACalifornia$195.40$61.78
Hanford, CACalifornia$195.40$61.78

46614 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.

$160.29

$222.06

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

View every state and territory as a table
46614 office rate range by state
State / territoryOffice rate rangeLocalities
AK$206.781
AL$162.891
AR$160.291
AZ$178.101
CA$195.40–$248.7129
CO$191.891
CT$196.341
DC$211.601
DE$181.251
FL$179.67–$197.503
GA$168.71–$186.872
GU$201.031
HI$201.031
IA$167.801
ID$168.931
IL$173.74–$191.654
IN$170.021
KS$166.771
KY$166.791
LA$166.44–$175.532
MA$190.51–$212.312
MD$185.00–$211.603
ME$169.73–$180.092
MI$171.42–$181.952
MN$183.821
MO$163.18–$176.413
MS$161.781
MT$183.361
NC$171.711
ND$180.201
NE$168.861
NH$188.661
NJ$198.57–$209.042
NM$172.391
NV$182.621
NY$174.52–$217.515
OH$170.771
OK$166.631
OR$181.20–$198.652
PA$171.16–$190.952
PR$184.891
RI$188.211
SC$171.531
SD$179.821
TN$167.671
TX$169.92–$191.258
UT$174.111
VA$179.33–$211.602
VI$184.891
VT$179.281
WA$190.22–$217.012
WI$173.571
WV$166.641
WY$181.981

See 46614 in every payment locality

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

Office or facility?

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.

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,607

Code
46614
Physician work
0.98
Practice expense
4.35
Malpractice
0.16

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 46614 in Iowa
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0000.9800
Practice expense4.35× 0.9153.9802
Malpractice0.16× 0.3970.0635
Total RVUs5.0238
Conversion factor× 33.4009

Office rate, Iowa$167.80

Office: (0.98 × 1 + 4.35 × 0.915 + 0.16 × 0.397) × $33.4009 = $167.80

Facility: (0.98 × 1 + 0.7 × 0.915 + 0.16 × 0.397) × $33.4009 = $56.25

Open 46614 in the RVU calculator

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

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

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%).

When to use modifier 51

Codes related to 46614

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

Codes related to 46614
CodeHow it relatesOffice range, Iowa
Same family
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without the bleeding-control work reported with 46614.$118.12
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy; report when tissue sampling, rather than hemostasis, is the service performed.$280.72
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with removal of a single lesion, a different treatment objective.$279.52
46615Anoscopy, lesion ablationAnoscopy with lesion ablation rather than control of bleeding as the primary service.$175.94

How 46614 has changed in Iowa

46614 · Office / nonfacility

$167.80

Effective 2026-10-01

The base rate is $21.16 higher than on 2025-10-01, moving from $146.64 to $167.80 (14.4%).

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

    $146.64changed to$167.80

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.00 changed to 0.98
    • Practice expense RVU 3.79 changed to 4.35
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $153.94changed to$146.64

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.89 changed to 3.79

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $151.43changed to$153.94

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $157.93changed to$151.43

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.94 changed to 3.89
    • Malpractice RVU 0.17 changed to 0.16
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $161.90changed to$157.93

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.99 changed to 3.94
    • Malpractice RVU 0.14 changed to 0.17
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $159.28changed to$161.90

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.86 changed to 3.99
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $138.55changed to$159.28

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.06 changed to 3.86
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $130.16changed to$138.55

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.80 changed to 3.06
    • Malpractice RVU 0.17 changed to 0.15
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $122.18changed to$130.16

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.56 changed to 2.80

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $119.45changed to$122.18

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.50 changed to 2.56
    • Malpractice RVU 0.16 changed to 0.17
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $118.83changed to$119.45

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $120.05changed to$118.83

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.53 changed to 2.50
    • Malpractice RVU 0.15 changed to 0.16

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $119.45changed to$120.05

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $117.92changed to$119.45

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.50 changed to 2.53
    • Malpractice RVU 0.13 changed to 0.15
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $120.09changed to$117.92

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.78 changed to 2.50
    • Malpractice RVU 0.14 changed to 0.13
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $120.09

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$167.80$56.25RVU26D
2026-07-01$167.80$56.25RVU26C
2026-04-01$167.80$56.25RVU26B
2026-01-01$167.80$56.25RVU26A
2025-10-01$146.64$58.04RVU25D
2025-07-01$146.64$58.04RVU25C
2025-04-01$146.64$58.04RVU25B
2025-01-01$146.64$58.04RVU25A
2024-10-01$153.94$59.12RVU24D
2024-07-01$153.94$59.12RVU24C
2024-04-01$153.94$59.12RVU24B
2024-03-09$153.94$59.12RVU24AR
2024-01-01$151.43$58.16RVU24A
2023-10-01$157.93$59.56RVU23D
2023-07-01$157.93$59.56RVU23C
2023-04-01$157.93$59.56RVU23B
2023-01-01$157.93$59.56RVU23A
2022-10-01$161.90$59.26RVU22D
2022-07-01$161.90$59.26RVU22C
2022-04-01$161.90$59.26RVU22B
2022-01-01$161.90$59.26RVU22A
2021-10-01$159.28$59.59RVU21D
2021-07-01$159.28$59.59RVU21C
2021-04-01$159.28$59.59RVU21B
2021-01-01$159.28$59.59RVU21A
2020-10-01$138.55$61.30RVU20D
2020-07-01$138.55$61.30RVU20C
2020-04-01$138.55$61.30RVU20B
2020-01-01$138.55$61.30RVU20A
2019-10-01$130.16$61.51RVU19D
2019-07-01$130.16$61.51RVU19C
2019-04-01$130.16$61.51RVU19B
2019-01-01$130.16$61.51RVU19A
2018-10-01$122.18$61.77RVU18D
2018-07-01$122.18$61.77RVU18C
2018-04-01$122.18$61.77RVU18B
2018-01-01$122.18$61.77RVU18AR1
2017-10-01$119.45$61.50RVU17D
2017-07-01$119.45$61.50RVU17C
2017-04-01$119.45$61.50RVU17B
2017-01-01$119.45$61.50RVU17A
2016-10-01$118.83$61.41RVU16D
2016-07-01$118.83$61.41RVU16C
2016-04-01$118.83$61.41RVU16B
2016-01-01$118.83$61.41RVU16A
2015-10-01$120.05$61.77RVU15D
2015-07-01$120.05$61.77RVU15C
2015-04-01$119.45$61.46RVU15B
2015-01-01$119.45$61.46RVU15A
2014-10-01$117.92$60.72RVU14D
2014-07-01$117.92$60.72RVU14C
2014-04-01$117.92$60.72RVU14B
2014-01-01$117.92$60.72RVU14A
2013-10-01$120.09$60.04RVU13D
2013-07-01$120.09$60.04RVU13C
2013-04-01$120.09$60.04RVU13B
2013-01-01$120.09$60.04RVU13AR

Price 46614 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

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

Show the CMS file lines behind this rate
RVUs for 46614PPRRVU2026_Oct_nonQPP.csv, line 5,607 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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