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

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 Nevada, Medicare pays $182.62 for 46614 in the office and $60.59 when it’s performed in a hospital or facility.

$182.62Office (non-facility)
$60.59Hospital or facility
−0.4%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 Nevada
  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 Nevada 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. Nevada pays $182.62. The RVUs are the same everywhere; the geographic indexes change the dollars.

46614 in Nevada vs other payment areas
  1. Nevada · this page$182.62
  2. Los Angeles, CA · California$209.51+$26.89
  3. Washington, DC area · District of Columbia$211.60+$28.98
  4. Miami, FL · Florida$197.50+$14.88
  5. Chicago, IL · Illinois$191.25+$8.63
  6. Manhattan, NY · New York$212.14+$29.52
  7. Alaska · Alaska$206.78+$24.16

Other areas in Nevada 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 Nevada 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

73

Locality
Nevada
Physician work
1.000
Practice expense
1.001
Malpractice
0.833
Office calculation for 46614 in Nevada
ComponentRVULocality factorAdjusted
Physician work0.98× 1.0000.9800
Practice expense4.35× 1.0014.3543
Malpractice0.16× 0.8330.1333
Total RVUs5.4676
Conversion factor× 33.4009

Office rate, Nevada$182.62

Office: (0.98 × 1 + 4.35 × 1.001 + 0.16 × 0.833) × $33.4009 = $182.62

Facility: (0.98 × 1 + 0.7 × 1.001 + 0.16 × 0.833) × $33.4009 = $60.59

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, Nevada
Same family
46600Diagnostic anoscopy, standard visualization, optional washingDiagnostic anoscopy without the bleeding-control work reported with 46614.$128.59
46606Anoscopy biopsy, biopsy performedAnoscopy with biopsy; report when tissue sampling, rather than hemostasis, is the service performed.$306.10
46610Anoscopy, hot forceps or bipolar cauteryAnoscopy with removal of a single lesion, a different treatment objective.$304.93
46615Anoscopy, lesion ablationAnoscopy with lesion ablation rather than control of bleeding as the primary service.$190.69

How 46614 has changed in Nevada

46614 · Office / nonfacility

$182.62

Effective 2026-10-01

The base rate is $23.31 higher than on 2025-10-01, moving from $159.31 to $182.62 (14.6%).

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

    $159.31changed to$182.62

    • 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 1.000 changed to 1.001
    • Malpractice GPCI 0.844 changed to 0.833

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $167.27changed to$159.31

    • 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

    $164.54changed to$167.27

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $173.73changed to$164.54

    • 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
    • Malpractice GPCI 1.098 changed to 0.844

  5. January 1, 2023

    RVU23A

    $179.40changed to$173.73

    • 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
    • Work GPCI 1.005 changed to 1.000
    • Malpractice GPCI 1.351 changed to 1.098

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $176.83changed to$179.40

    • 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

    $152.79changed to$176.83

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.06 changed to 3.86
    • Work GPCI 1.004 changed to 1.005
    • Malpractice GPCI 1.130 changed to 1.351

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $144.31changed to$152.79

    • 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
    • Work GPCI 1.002 changed to 1.004
    • Practice expense GPCI 1.017 changed to 1.000
    • Malpractice GPCI 0.909 changed to 1.130

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $135.36changed to$144.31

    • 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

    $134.24changed to$135.36

    • 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
    • Work GPCI 1.004 changed to 1.002
    • Practice expense GPCI 1.034 changed to 1.017
    • Malpractice GPCI 0.946 changed to 0.909

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $135.68changed to$134.24

    • Conversion factor 35.8043 changed to 35.8887
    • Work GPCI 1.005 changed to 1.004
    • Practice expense GPCI 1.051 changed to 1.034
    • Malpractice GPCI 0.982 changed to 0.946

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $136.95changed to$135.68

    • 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

    $136.27changed to$136.95

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $135.50changed to$136.27

    • 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
    • Work GPCI 1.001 changed to 1.005
    • Practice expense GPCI 1.055 changed to 1.051
    • Malpractice GPCI 1.107 changed to 0.982

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $139.96changed to$135.50

    • 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
    • Work GPCI 1.000 changed to 1.001
    • Practice expense GPCI 1.058 changed to 1.055
    • Malpractice GPCI 1.232 changed to 1.107

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$139.96

  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$182.62$60.59RVU26D
2026-07-01$182.62$60.59RVU26C
2026-04-01$182.62$60.59RVU26B
2026-01-01$182.62$60.59RVU26A
2025-10-01$159.31$62.27RVU25D
2025-07-01$159.31$62.27RVU25C
2025-04-01$159.31$62.27RVU25B
2025-01-01$159.31$62.27RVU25A
2024-10-01$167.27$63.41RVU24D
2024-07-01$167.27$63.41RVU24C
2024-04-01$167.27$63.41RVU24B
2024-03-09$167.27$63.41RVU24AR
2024-01-01$164.54$62.38RVU24A
2023-10-01$173.73$65.63RVU23D
2023-07-01$173.73$65.63RVU23C
2023-04-01$173.73$65.63RVU23B
2023-01-01$173.73$65.63RVU23A
2022-10-01$179.40$66.24RVU22D
2022-07-01$179.40$66.24RVU22C
2022-04-01$179.40$66.24RVU22B
2022-01-01$179.40$66.24RVU22A
2021-10-01$176.83$66.91RVU21D
2021-07-01$176.83$66.91RVU21C
2021-04-01$176.83$66.91RVU21B
2021-01-01$176.83$66.91RVU21A
2020-10-01$152.79$67.61RVU20D
2020-07-01$152.79$67.61RVU20C
2020-04-01$152.79$67.61RVU20B
2020-01-01$152.79$67.61RVU20A
2019-10-01$144.31$67.34RVU19D
2019-07-01$144.31$67.34RVU19C
2019-04-01$144.31$67.34RVU19B
2019-01-01$144.31$67.34RVU19A
2018-10-01$135.36$67.63RVU18D
2018-07-01$135.36$67.63RVU18C
2018-04-01$135.36$67.63RVU18B
2018-01-01$135.36$67.63RVU18AR1
2017-10-01$134.24$67.81RVU17D
2017-07-01$134.24$67.81RVU17C
2017-04-01$134.24$67.81RVU17B
2017-01-01$134.24$67.81RVU17A
2016-10-01$135.68$68.33RVU16D
2016-07-01$135.68$68.33RVU16C
2016-04-01$135.68$68.33RVU16B
2016-01-01$135.68$68.33RVU16A
2015-10-01$136.95$68.60RVU15D
2015-07-01$136.95$68.60RVU15C
2015-04-01$136.27$68.26RVU15B
2015-01-01$136.27$68.26RVU15A
2014-10-01$135.50$67.85RVU14D
2014-07-01$135.50$67.85RVU14C
2014-04-01$135.50$67.85RVU14B
2014-01-01$135.50$67.85RVU14A
2013-10-01$139.96$68.33RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 46614 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

  • Alamo
  • Amargosa Valley
  • Austin
  • Baker
  • Battle Mountain
  • Beatty
  • Beaverdam
  • Bennett Springs

Browse all communities in Nevada

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 NevadaGPCI2026.csv, line 73 (RVU26D)

Open CMS sourceHow we calculate rates

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