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CPT code 46930: Hemorrhoid treatment, thermal energy2026 Medicare rate & RVUs in Puerto Rico

Report 46930 when a clinician treats internal hemorrhoids by thermal energy, including infrared coagulation, rather than ligation or excision.

CMS RVU26DEffective Oct 1, 2026One payment locality4.9K Medicare services in 2024

In Puerto Rico, Medicare pays $249.79 for 46930 in the office and $158.62 when it’s performed in a hospital or facility.

$249.79Office (non-facility)
$158.62Hospital or facility
+0.8%vs the national office rate ($247.83)

Check a contract rate as a % of Medicare · 46930 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 46930 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 46930 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 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.

How Puerto Rico compares for 46930

Across 109 of 109 payment localities, the office rate for 46930 runs from $217.76 in Arkansas to $333.31 in San Benito County, CA. Puerto Rico pays $249.79. The RVUs are the same everywhere; the geographic indexes change the dollars.

46930 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$249.79
  2. Los Angeles, CA · California$281.93+$32.14
  3. Washington, DC area · District of Columbia$284.97+$35.18
  4. Miami, FL · Florida$266.78+$16.99
  5. Chicago, IL · Illinois$258.66+$8.87
  6. Manhattan, NY · New York$285.96+$36.17
  7. Alaska · Alaska$282.98+$33.19

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

Every other payment area

46930 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$221.14$142.23
ArkansasArkansas$217.76$140.29
ArizonaArizona$240.95$153.56
Bakersfield, CACalifornia$264.01$165.17
Chico, CACalifornia$263.37$164.53
El Centro, CACalifornia$263.41$164.57
Fresno, CACalifornia$263.37$164.53
Hanford, CACalifornia$263.37$164.53

46930 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.

$217.76

$298.34

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

View every state and territory as a table
46930 office rate range by state
State / territoryOffice rate rangeLocalities
AK$282.981
AL$221.141
AR$217.761
AZ$240.951
CA$263.37–$333.3129
CO$258.891
CT$264.911
DC$284.971
DE$245.101
FL$243.26–$266.783
GA$228.94–$252.482
GU$270.501
HI$270.501
IA$227.421
ID$228.921
IL$235.61–$258.954
IN$230.331
KS$226.141
KY$226.341
LA$225.90–$237.742
MA$257.15–$285.662
MD$250.01–$284.973
ME$230.01–$243.432
MI$232.42–$246.292
MN$248.111
MO$221.69–$238.823
MS$219.781
MT$247.821
NC$232.581
ND$243.471
NE$228.781
NH$254.631
NJ$267.95–$281.732
NM$233.701
NV$246.801
NY$236.25–$293.035
OH$231.531
OK$226.071
OR$244.90–$267.672
PA$232.01–$257.912
PR$249.791
RI$254.241
SC$232.441
SD$242.961
TN$227.321
TX$230.39–$258.018
UT$235.801
VA$242.48–$284.972
VI$249.791
VT$242.321
WA$256.73–$291.802
WI$234.851
WV$226.371
WY$245.921

See 46930 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,636

Code
46930
Physician work
1.57
Practice expense
5.63
Malpractice
0.22

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 46930 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.57× 1.0001.5700
Practice expense5.63× 1.0115.6919
Malpractice0.22× 0.9850.2167
Total RVUs7.4786
Conversion factor× 33.4009

Office rate, Puerto Rico$249.79

Office: (1.57 × 1 + 5.63 × 1.011 + 0.22 × 0.985) × $33.4009 = $249.79

Facility: (1.57 × 1 + 2.93 × 1.011 + 0.22 × 0.985) × $33.4009 = $158.62

Open 46930 in the RVU calculator

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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

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%).

When to use modifier 51

Codes related to 46930

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

Codes related to 46930
CodeHow it relatesOffice range, Puerto Rico
Used instead
46945Hemorrhoid ligation, one column, no imagingRubber-band ligation of one internal hemorrhoid is a different treatment method.No office rate
46946Hemorrhoid ligation, two or more, without imagingRubber-band ligation of multiple internal hemorrhoids uses a separate code.No office rate
46947Hemorrhoidopexy, stapled techniqueStapled hemorrhoidopexy is an operative alternative, not thermal destruction.No office rate
46948Hemorrhoid surgery, doppler-guided, two or more columnsTransanal hemorrhoidal dearterialization is a distinct operative approach.No office rate

How 46930 has changed in Puerto Rico

46930 · Office / nonfacility

$249.79

Effective 2026-10-01

The base rate is $33.73 higher than on 2025-10-01, moving from $216.06 to $249.79 (15.6%).

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

    $216.06changed to$249.79

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.61 changed to 1.57
    • Practice expense RVU 4.81 changed to 5.63
    • Malpractice RVU 0.23 changed to 0.22
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $217.99changed to$216.06

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.68 changed to 4.81

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $214.43changed to$217.99

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $221.41changed to$214.43

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.67 changed to 4.68
    • Malpractice RVU 0.22 changed to 0.23
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $220.27changed to$221.41

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $228.22changed to$220.27

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.73 changed to 4.67
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $230.12changed to$228.22

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.74 changed to 4.73
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $222.01changed to$230.12

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.29 changed to 4.74
    • Malpractice RVU 0.22 changed to 0.21
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $217.93changed to$222.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.18 changed to 4.29
    • Malpractice RVU 0.23 changed to 0.22
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $215.51changed to$217.93

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.12 changed to 4.18

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $186.96changed to$215.51

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.04 changed to 4.12
    • Malpractice RVU 0.22 changed to 0.23
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $161.68changed to$186.96

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.03 changed to 4.04
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $163.38changed to$161.68

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.07 changed to 4.03
    • Malpractice RVU 0.23 changed to 0.22

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $162.57changed to$163.38

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $157.52changed to$162.57

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.93 changed to 4.07
    • Malpractice RVU 0.25 changed to 0.23
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $158.48changed to$157.52

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 4.40 changed to 3.93
    • Malpractice RVU 0.26 changed to 0.25
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $158.48

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$249.79$158.62RVU26D
2026-07-01$249.79$158.62RVU26C
2026-04-01$249.79$158.62RVU26B
2026-01-01$249.79$158.62RVU26A
2025-10-01$216.06$151.57RVU25D
2025-07-01$216.06$151.57RVU25C
2025-04-01$216.06$151.57RVU25B
2025-01-01$216.06$151.57RVU25A
2024-10-01$217.99$152.96RVU24D
2024-07-01$217.99$152.96RVU24C
2024-04-01$217.99$152.96RVU24B
2024-03-09$217.99$152.96RVU24AR
2024-01-01$214.43$150.46RVU24A
2023-10-01$221.41$154.46RVU23D
2023-07-01$220.27$153.85RVU23C
2023-04-01$220.27$153.85RVU23B
2023-01-01$220.27$153.85RVU23A
2022-10-01$228.22$158.10RVU22D
2022-07-01$228.22$158.10RVU22C
2022-04-01$228.22$158.10RVU22B
2022-01-01$228.22$158.10RVU22A
2021-10-01$230.12$158.02RVU21D
2021-07-01$230.12$158.02RVU21C
2021-04-01$230.12$158.02RVU21B
2021-01-01$230.12$158.02RVU21A
2020-10-01$222.01$156.89RVU20D
2020-07-01$222.01$156.89RVU20C
2020-04-01$222.01$156.89RVU20B
2020-01-01$222.01$156.89RVU20A
2019-10-01$217.93$154.78RVU19D
2019-07-01$217.93$154.78RVU19C
2019-04-01$217.93$154.78RVU19B
2019-01-01$217.93$154.78RVU19A
2018-10-01$215.51$153.89RVU18D
2018-07-01$215.51$153.89RVU18C
2018-04-01$215.51$153.89RVU18B
2018-01-01$215.51$153.89RVU18AR1
2017-10-01$186.96$136.27RVU17D
2017-07-01$186.96$136.27RVU17C
2017-04-01$186.96$136.27RVU17B
2017-01-01$186.96$136.27RVU17A
2016-10-01$161.68$120.28RVU16D
2016-07-01$161.68$120.28RVU16C
2016-04-01$161.68$120.28RVU16B
2016-01-01$161.68$120.28RVU16A
2015-10-01$163.38$121.83RVU15D
2015-07-01$163.38$121.83RVU15C
2015-04-01$162.57$121.23RVU15B
2015-01-01$162.57$121.23RVU15A
2014-10-01$157.52$118.11RVU14D
2014-07-01$157.52$118.11RVU14C
2014-04-01$157.52$118.11RVU14B
2014-01-01$157.52$118.11RVU14A
2013-10-01$158.48$117.42RVU13D
2013-07-01$158.48$117.42RVU13C
2013-04-01$158.48$117.42RVU13B
2013-01-01$158.48$117.42RVU13AR

Price 46930 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 46930PPRRVU2026_Oct_nonQPP.csv, line 5,636 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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