CPT code 46615: Anoscopy, lesion ablation2026 Medicare rate & RVUs in Riverside, CA
Anoscopy with lesion ablation treats one or more anal canal lesions under direct visualization when tissue is destroyed rather than removed for pathology.
In Riverside, CA, Medicare pays $204.62 for 46615 in the office and $86.38 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 46615 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 46615 covers
This service combines examination of the anal canal through an anoscope with destruction of one or more identified lesions. It may be used to treat anal condyloma or dysplastic lesions when the clinician selects an ablative approach, such as cautery or another method that destroys the target tissue. Colorectal surgeons and other clinicians trained in anorectal procedures commonly perform it in an office or procedure-room setting, or in a facility. It is distinct from a diagnostic anoscopy and from procedures that remove a lesion for examination as a specimen.
Report the service when documentation supports anoscopic visualization and treatment by ablation, and identifies the lesion or lesions treated. Do not select it merely because a lesion was observed or sampled; biopsy and removal methods have separate codes. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 Riverside, CA compares for 46615
Across 109 of 109 payment localities, the office rate for 46615 runs from $169.15 in Arkansas to $253.92 in San Benito County, CA. Riverside, CA pays $204.62. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Riverside, CA · this page$204.62
- Bakersfield, CA · California$202.96−$1.66
- Chico, CA · California$202.35−$2.27
- El Centro, CA · California$202.38−$2.24
- Fresno, CA · California$202.35−$2.27
- Hanford, CA · California$202.35−$2.27
- Los Angeles, CA · California$216.24+$11.62
Other areas in California first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| Madera, CACalifornia | $202.35 | $84.10 |
| Merced, CACalifornia | $202.35 | $84.10 |
| Modesto, CACalifornia | $202.35 | $84.10 |
| Napa, CACalifornia | $234.57 | $92.38 |
| Oxnard, CACalifornia | $215.18 | $87.66 |
| Redding, CACalifornia | $202.35 | $84.10 |
| Rest of CaliforniaCalifornia | $202.35 | $84.10 |
| Sacramento, CACalifornia | $212.38 | $86.91 |
| Salinas, CACalifornia | $211.59 | $86.55 |
| San Diego, CACalifornia | $216.62 | $87.59 |
| Marin County, CACalifornia | $248.30 | $96.18 |
| San Francisco, CACalifornia | $248.06 | $95.94 |
| San Benito County, CACalifornia | $253.92 | $98.35 |
| Santa Clara County, CACalifornia | $252.94 | $97.37 |
| San Luis Obispo, CACalifornia | $208.19 | $85.31 |
| Santa Cruz, CACalifornia | $218.72 | $87.64 |
| Santa Maria, CACalifornia | $212.40 | $86.60 |
| Santa Rosa, CACalifornia | $220.92 | $88.44 |
| Stockton, CACalifornia | $202.35 | $84.10 |
| Vallejo, CACalifornia | $234.23 | $92.04 |
| Visalia, CACalifornia | $202.35 | $84.10 |
| Yuba City, CACalifornia | $202.35 | $84.10 |
| Washington, DC areaDistrict of Columbia | $219.34 | $92.26 |
| Miami, FLFlorida | $208.02 | $95.71 |
| Chicago, ILIllinois | $201.83 | $93.40 |
| Manhattan, NYNew York | $220.98 | $95.61 |
| AlaskaAlaska | $221.79 | $106.89 |
| AlabamaAlabama | $171.68 | $77.29 |
| ArkansasArkansas | $169.15 | $76.48 |
| ArizonaArizona | $186.50 | $81.96 |
| ColoradoColorado | $199.47 | $84.68 |
| ConnecticutConnecticut | $204.64 | $88.44 |
| DelawareDelaware | $189.63 | $83.03 |
| Fort Lauderdale, FLFlorida | $199.16 | $89.87 |
| Rest of FloridaFlorida | $189.27 | $86.13 |
| Atlanta, GAGeorgia | $195.45 | $85.84 |
| Rest of GeorgiaGeorgia | $178.39 | $82.15 |
| Hawaii, Guam, HIHawaii | $207.39 | $84.73 |
| IowaIowa | $175.94 | $77.22 |
| IdahoIdaho | $177.15 | $77.90 |
| East St. Louis, ILIllinois | $187.96 | $88.70 |
| Rest of IllinoisIllinois | $183.84 | $85.34 |
| Suburban Chicago, ILIllinois | $201.15 | $90.35 |
| IndianaIndiana | $178.19 | $78.18 |
| KansasKansas | $175.19 | $77.66 |
| KentuckyKentucky | $176.04 | $80.13 |
| New Orleans, LALouisiana | $184.65 | $83.13 |
| Rest of LouisianaLouisiana | $175.79 | $80.32 |
| Metropolitan Boston, MAMassachusetts | $219.32 | $90.51 |
| Rest of MassachusettsMassachusetts | $198.28 | $84.68 |
| Baltimore area, MDMaryland | $204.09 | $88.33 |
| Rest of MarylandMaryland | $193.26 | $84.09 |
| Rest of MaineMaine | $178.19 | $78.94 |
| Southern Maine, MEMaine | $187.91 | $81.00 |
| Detroit, MIMichigan | $191.77 | $87.67 |
| Rest of MichiganMichigan | $180.80 | $82.30 |
| MinnesotaMinnesota | $190.73 | $79.71 |
| Metropolitan Kansas City, MOMissouri | $183.27 | $81.96 |
| Metropolitan St. Louis, MOMissouri | $185.21 | $82.50 |
| Rest of MissouriMissouri | $172.78 | $79.78 |
| MississippiMississippi | $170.99 | $78.11 |
| MontanaMontana | $191.71 | $83.82 |
| North CarolinaNorth Carolina | $180.08 | $79.42 |
| North DakotaNorth Dakota | $187.55 | $79.67 |
| NebraskaNebraska | $176.89 | $77.31 |
| New HampshireNew Hampshire | $196.42 | $84.11 |
| Northern New JerseyNew Jersey | $217.02 | $91.87 |
| Rest of New JerseyNew Jersey | $206.86 | $89.05 |
| New MexicoNew Mexico | $181.85 | $82.92 |
| NevadaNevada | $190.69 | $82.69 |
| NYC suburbs and Long Island, NYNew York | $226.55 | $98.27 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $208.30 | $90.17 |
| Queens, NYNew York | $222.68 | $95.16 |
| Rest of New YorkNew York | $182.84 | $80.35 |
| OhioOhio | $179.95 | $81.45 |
| OklahomaOklahoma | $175.61 | $79.27 |
| Portland, OROregon | $205.80 | $85.94 |
| Rest of OregonOregon | $189.09 | $81.64 |
| Metropolitan Philadelphia, PAPennsylvania | $199.53 | $87.22 |
| Rest of PennsylvaniaPennsylvania | $180.19 | $81.15 |
| Puerto RicoPuerto Rico | $193.11 | $84.04 |
| Rhode IslandRhode Island | $196.38 | $84.93 |
| South CarolinaSouth Carolina | $180.34 | $80.65 |
| South DakotaSouth Dakota | $187.06 | $79.18 |
| TennesseeTennessee | $176.10 | $78.04 |
| Austin, TXTexas | $198.90 | $84.76 |
| Beaumont, TXTexas | $178.99 | $80.81 |
| Brazoria, TXTexas | $189.34 | $82.43 |
| Dallas, TXTexas | $190.62 | $83.17 |
| Fort Worth, TXTexas | $189.35 | $82.98 |
| Galveston, TXTexas | $189.95 | $82.82 |
| Houston, TXTexas | $193.80 | $86.67 |
| Rest of TexasTexas | $184.11 | $81.72 |
| UtahUtah | $182.85 | $81.44 |
| VirginiaVirginia | $187.35 | $81.30 |
| Virgin Islands, VIUnited States Virgin Islands | $193.11 | $84.04 |
| VermontVermont | $186.90 | $80.09 |
| Rest of WashingtonWashington | $197.88 | $84.28 |
| King County, WAWashington | $223.73 | $91.36 |
| WisconsinWisconsin | $181.16 | $77.80 |
| West VirginiaWest Virginia | $176.94 | $83.18 |
| WyomingWyoming | $189.90 | $82.01 |
46615 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.
$169.15
$228.14
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 | $221.79 | 1 |
| AL | $171.68 | 1 |
| AR | $169.15 | 1 |
| AZ | $186.50 | 1 |
| CA | $202.35–$253.92 | 29 |
| CO | $199.47 | 1 |
| CT | $204.64 | 1 |
| DC | $219.34 | 1 |
| DE | $189.63 | 1 |
| FL | $189.27–$208.02 | 3 |
| GA | $178.39–$195.45 | 2 |
| GU | $207.39 | 1 |
| HI | $207.39 | 1 |
| IA | $175.94 | 1 |
| ID | $177.15 | 1 |
| IL | $183.84–$201.83 | 4 |
| IN | $178.19 | 1 |
| KS | $175.19 | 1 |
| KY | $176.04 | 1 |
| LA | $175.79–$184.65 | 2 |
| MA | $198.28–$219.32 | 2 |
| MD | $193.26–$219.34 | 3 |
| ME | $178.19–$187.91 | 2 |
| MI | $180.80–$191.77 | 2 |
| MN | $190.73 | 1 |
| MO | $172.78–$185.21 | 3 |
| MS | $170.99 | 1 |
| MT | $191.71 | 1 |
| NC | $180.08 | 1 |
| ND | $187.55 | 1 |
| NE | $176.89 | 1 |
| NH | $196.42 | 1 |
| NJ | $206.86–$217.02 | 2 |
| NM | $181.85 | 1 |
| NV | $190.69 | 1 |
| NY | $182.84–$226.55 | 5 |
| OH | $179.95 | 1 |
| OK | $175.61 | 1 |
| OR | $189.09–$205.80 | 2 |
| PA | $180.19–$199.53 | 2 |
| PR | $193.11 | 1 |
| RI | $196.38 | 1 |
| SC | $180.34 | 1 |
| SD | $187.06 | 1 |
| TN | $176.10 | 1 |
| TX | $178.99–$198.90 | 8 |
| UT | $182.85 | 1 |
| VA | $187.35–$219.34 | 2 |
| VI | $193.11 | 1 |
| VT | $186.90 | 1 |
| WA | $197.88–$223.73 | 2 |
| WI | $181.16 | 1 |
| WV | $176.94 | 1 |
| WY | $189.90 | 1 |
How the 46615 rate is calculated
Each of 46615’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 · 46615
RVUs × geographic indexes × conversion factor
Work1.46
1.46 RVUs× 1.000 GPCI
Practice expense4.07
4.07 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
5.7400
Conversion factor
$33.4009
Medicare rate
$191.72
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Riverside, CA inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,608
- Code
- 46615
- Physician work
- 1.46
- Practice expense
- 4.07
- Malpractice
- 0.21
GPCI2026.csv
20
- Locality
- Riverside, CA
- Physician work
- 1.018
- Practice expense
- 1.096
- Malpractice
- 0.853
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.46 | × 1.018 | 1.4863 |
| Practice expense | 4.07 | × 1.096 | 4.4607 |
| Malpractice | 0.21 | × 0.853 | 0.1791 |
| Total RVUs | 6.1261 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Riverside, CA$204.62
Office: (1.46 × 1.018 + 4.07 × 1.096 + 0.21 × 0.853) × $33.4009 = $204.62
Facility: (1.46 × 1.018 + 0.84 × 1.096 + 0.21 × 0.853) × $33.4009 = $86.38
Payment rules and modifiers for 46615
The CMS indicators that decide how 46615 is paid alongside other services.
CMS payment indicators · 46615
Anoscopy, lesion ablation
| 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
46615 without 51 · national office
$191.72
Anoscopy, lesion ablation
46615-51 · Second procedure: 50%
$95.86
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%).
How 46615 has changed in Riverside, CA
46615 · Office / nonfacility
$204.62
Effective 2026-10-01
The base rate is $25.62 higher than on 2025-10-01, moving from $179.00 to $204.62 (14.3%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$179.00changed to$204.62
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.50 changed to 1.46
- Practice expense RVU 3.50 changed to 4.07
- Work GPCI 1.014 changed to 1.018
- Practice expense GPCI 1.093 changed to 1.096
- Malpractice GPCI 0.892 changed to 0.853
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$188.21changed to$179.00
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.61 changed to 3.50
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$185.14changed to$188.21
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$191.67changed to$185.14
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.66 changed to 3.61
- Malpractice RVU 0.19 changed to 0.21
- Work GPCI 1.021 changed to 1.014
- Practice expense GPCI 1.079 changed to 1.093
- Malpractice GPCI 0.924 changed to 0.892
January 1, 2023
RVU23A
$200.34changed to$191.67
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 3.81 changed to 3.66
- Malpractice RVU 0.20 changed to 0.19
- Work GPCI 1.027 changed to 1.021
- Practice expense GPCI 1.065 changed to 1.079
- Malpractice GPCI 0.955 changed to 0.924
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$196.07changed to$200.34
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.67 changed to 3.81
- Malpractice RVU 0.19 changed to 0.20
- Malpractice GPCI 0.896 changed to 0.955
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$173.32changed to$196.07
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 2.89 changed to 3.67
- Malpractice RVU 0.21 changed to 0.19
- Work GPCI 1.024 changed to 1.027
- Practice expense GPCI 1.070 changed to 1.065
- Malpractice GPCI 0.830 changed to 0.896
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$162.46changed to$173.32
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 2.61 changed to 2.89
- Malpractice RVU 0.23 changed to 0.21
- Work GPCI 1.021 changed to 1.024
- Practice expense GPCI 1.074 changed to 1.070
- Malpractice GPCI 0.753 changed to 0.830
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$153.55changed to$162.46
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.38 changed to 2.61
- Malpractice RVU 0.26 changed to 0.23
- Work GPCI 1.020 changed to 1.021
- Malpractice GPCI 0.689 changed to 0.753
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$150.87changed to$153.55
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 2.31 changed to 2.38
- Malpractice RVU 0.28 changed to 0.26
- Work GPCI 1.024 changed to 1.020
- Practice expense GPCI 1.079 changed to 1.074
- Malpractice GPCI 0.626 changed to 0.689
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$150.87
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $204.62 | $86.38 | RVU26D |
| 2026-07-01 | $204.62 | $86.38 | RVU26C |
| 2026-04-01 | $204.62 | $86.38 | RVU26B |
| 2026-01-01 | $204.62 | $86.38 | RVU26A |
| 2025-10-01 | $179.00 | $90.97 | RVU25D |
| 2025-07-01 | $179.00 | $90.97 | RVU25C |
| 2025-04-01 | $179.00 | $90.97 | RVU25B |
| 2025-01-01 | $179.00 | $90.97 | RVU25A |
| 2024-10-01 | $188.21 | $93.25 | RVU24D |
| 2024-07-01 | $188.21 | $93.25 | RVU24C |
| 2024-04-01 | $188.21 | $93.25 | RVU24B |
| 2024-03-09 | $188.21 | $93.25 | RVU24AR |
| 2024-01-01 | $185.14 | $91.73 | RVU24A |
| 2023-10-01 | $191.67 | $93.68 | RVU23D |
| 2023-07-01 | $191.67 | $93.68 | RVU23C |
| 2023-04-01 | $191.67 | $93.68 | RVU23B |
| 2023-01-01 | $191.67 | $93.68 | RVU23A |
| 2022-10-01 | $200.34 | $96.41 | RVU22D |
| 2022-07-01 | $200.34 | $96.41 | RVU22C |
| 2022-04-01 | $200.34 | $96.41 | RVU22B |
| 2022-01-01 | $200.34 | $96.41 | RVU22A |
| 2021-10-01 | $196.07 | $95.74 | RVU21D |
| 2021-07-01 | $196.07 | $95.74 | RVU21C |
| 2021-04-01 | $196.07 | $95.74 | RVU21B |
| 2021-01-01 | $196.07 | $95.74 | RVU21A |
| 2020-10-01 | $173.32 | $97.64 | RVU20D |
| 2020-07-01 | $173.32 | $97.64 | RVU20C |
| 2020-04-01 | $173.32 | $97.64 | RVU20B |
| 2020-01-01 | $173.32 | $97.64 | RVU20A |
| 2019-10-01 | $162.46 | $96.66 | RVU19D |
| 2019-07-01 | $162.46 | $96.66 | RVU19C |
| 2019-04-01 | $162.46 | $96.66 | RVU19B |
| 2019-01-01 | $162.46 | $96.66 | RVU19A |
| 2018-10-01 | $153.55 | $96.71 | RVU18D |
| 2018-07-01 | $153.55 | $96.71 | RVU18C |
| 2018-04-01 | $153.55 | $96.71 | RVU18B |
| 2018-01-01 | $153.55 | $96.71 | RVU18AR1 |
| 2017-10-01 | $150.87 | $96.27 | RVU17D |
| 2017-07-01 | $150.87 | $96.27 | RVU17C |
| 2017-04-01 | $150.87 | $96.27 | RVU17B |
| 2017-01-01 | $150.87 | $96.27 | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Rate data unavailable | Rate data unavailable | RVU13D |
| 2013-07-01 | Rate data unavailable | Rate data unavailable | RVU13C |
| 2013-04-01 | Rate data unavailable | Rate data unavailable | RVU13B |
| 2013-01-01 | Rate data unavailable | Rate data unavailable | RVU13AR |
Where the Riverside, CA rate applies
Riverside, CA is a Medicare payment area, not a city. Our Census mapping connects it to 127 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.
- Ontario
- Riverside
- San Bernardino
- Adelanto
- Aguanga
- Anza
- Apple Valley
- Baker
46615 billing questions
How is this different from diagnostic anoscopy?
This code is for anoscopy that includes ablation of one or more lesions. Use a diagnostic anoscopy code when the examination is performed without lesion ablation.
Can this code be reported when a lesion is biopsied?
The service described here is ablation, not biopsy. If tissue is sampled or removed for pathology, select the code that matches the documented biopsy or removal technique rather than treating this as a biopsy code.
How does it differ from anoscopic lesion removal?
Choose an anoscopic removal code when the clinician removes a lesion using the technique specified by that code. This code describes destruction of lesion tissue by ablation.
What documentation supports reporting it?
Document anoscopic visualization, the lesion or lesions treated, and the ablative treatment performed. The note should distinguish ablation from biopsy or physical removal.
What happens when another related endoscopy is performed at the same session?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The claim should reflect the services actually performed and their relationship.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for the service; co-surgeons 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
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