CPT code 46946: Hemorrhoid ligation, two or more, without imaging2026 Medicare rate & RVUs

Medicare pays $383.78 for 46946 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 46946 covers

A surgeon treats at least two internal hemorrhoids by ligating them without imaging guidance. This is a surgical approach, distinct from office rubber-band ligation and from Doppler-guided transanal hemorrhoidal dearterialization. Colorectal and general surgeons commonly perform it in an operating room or ambulatory surgery setting for symptomatic internal hemorrhoids when operative ligation is selected.

Choose this code when two or more hemorrhoids are treated during the procedure; use the single-hemorrhoid code when only one is treated. The operative report should support the number treated and the ligation method, including that imaging guidance was not used. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing 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 46946 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

46946 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 46946 rate is calculated

Each of 46946’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.

Payment rules and modifiers for 46946

46946 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

46946 compared with similar codes

How to choose

46945Hemorrhoid ligationOne column, no imaging

Use 46945 when one internal hemorrhoid is treated by ligation without imaging guidance; use 46946 when two or more are treated.

46948Hemorrhoid surgeryDoppler-guided, two or more columns

46948 describes transanal hemorrhoidal dearterialization with imaging guidance. This code is for ligation of multiple hemorrhoids without imaging guidance.

46930Hemorrhoid treatmentThermal energy

46930 describes destruction of internal hemorrhoids, not the surgical ligation represented by 46946.

46947HemorrhoidopexyStapled technique

46947 is for stapled hemorrhoidopexy, a distinct operative method rather than ligation of multiple internal hemorrhoids.

Codes related to 46946

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

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

Open CMS sourceHow we calculate rates