CPT code 46930: Hemorrhoid treatment, thermal energy2026 Medicare rate & RVUs in California
Report 46930 when a clinician treats internal hemorrhoids by thermal energy, including infrared coagulation, rather than ligation or excision.
Medicare pays $263.37–$333.31 for 46930 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
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 9 sections
What 46930 covers
A clinician applies thermal energy to internal hemorrhoidal tissue, commonly using an infrared coagulation device through an anoscope. Colorectal surgeons, general surgeons, and gastroenterologists may perform the treatment in an office or outpatient setting for symptomatic internal hemorrhoids selected for this approach.
Report 46930 for thermal destruction, including infrared coagulation; rubber-band ligation and operative hemorrhoid procedures are different services. Documentation should identify the internal hemorrhoids and the thermal treatment performed. The code has a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 46930 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$263.37 to $333.31
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $264.01 | $165.17 |
| Chico, CA | $263.37 | $164.53 |
| El Centro, CA | $263.41 | $164.57 |
| Fresno, CA | $263.37 | $164.53 |
| Hanford, CA | $263.37 | $164.53 |
| Los Angeles, CA | $281.93 | $175.24 |
| Madera, CA | $263.37 | $164.53 |
| Marin County, CA | $325.94 | $198.78 |
| Merced, CA | $263.37 | $164.53 |
| Modesto, CA | $263.37 | $164.53 |
| Napa, CA | $307.32 | $188.46 |
| Oxnard, CA | $280.76 | $174.16 |
| Redding, CA | $263.37 | $164.53 |
| Rest of California | $263.37 | $164.53 |
| Riverside, CA | $265.75 | $166.91 |
| Sacramento, CA | $276.96 | $172.08 |
| Salinas, CA | $275.95 | $171.43 |
| San Benito County, CA | $333.31 | $203.27 |
| San Diego, CA | $282.90 | $175.04 |
| San Francisco, CA | $325.69 | $198.53 |
| San Luis Obispo, CA | $271.46 | $168.74 |
| Santa Clara County, CA | $332.29 | $202.25 |
| Santa Cruz, CA | $285.96 | $176.38 |
| Santa Maria, CA | $277.11 | $171.96 |
| Santa Rosa, CA | $288.87 | $178.13 |
| Stockton, CA | $263.37 | $164.53 |
| Vallejo, CA | $306.96 | $188.10 |
| Visalia, CA | $263.37 | $164.53 |
| Yuba City, CA | $263.37 | $164.53 |
How the 46930 rate is calculated
Each of 46930’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 · 46930
RVUs × geographic indexes × conversion factor
Work1.57
1.57 RVUs× 1.000 GPCI
Practice expense5.63
5.63 RVUs× 1.000 GPCI
Malpractice0.22
0.22 RVUs× 1.000 GPCI
Adjusted RVUs
7.4200
Conversion factor
$33.4009
Medicare rate
$247.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46930
46930 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46930
Hemorrhoid treatment, thermal energy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46930
Hemorrhoid treatment, thermal energy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46930 without 51 · national office
$247.83
Hemorrhoid treatment, thermal energy
46930-51 · Second procedure: 50%
$123.92
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%).
46930 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46945Hemorrhoid ligationOne column, no imaging
- 46945 describes ligation of one internal hemorrhoid. Choose 46930 when thermal energy is used instead of ligation.
- 46946Hemorrhoid ligationTwo or more, without imaging
- 46946 describes ligation of two or more internal hemorrhoids. Thermal destruction is reported with 46930, regardless of whether one or multiple hemorrhoids are treated.
- 46947HemorrhoidopexyStapled technique
- 46947 represents stapled hemorrhoidopexy, an operative procedure; 46930 represents thermal destruction of internal hemorrhoidal tissue.
- 46900Anal lesion destructionSimple lesions
- 46900 is for destruction of anal lesion(s), not thermal treatment of internal hemorrhoids. Identify the treated condition and method.
46930 billing questions
When should 46930 be chosen instead of hemorrhoid ligation?
Use 46930 when thermal energy, such as infrared coagulation, destroys internal hemorrhoidal tissue. Rubber-band ligation is reported with the applicable ligation code, such as 46945 or 46946.
Does the number of hemorrhoids treated determine separate units?
The descriptor covers internal hemorrhoid or hemorrhoids. Document the treatment performed; do not assume each treated hemorrhoid is a separate unit.
Is follow-up care included in the procedure payment?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for treatment on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
When is an assistant at surgery payable?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others at 50%.
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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