CPT code 46946: Hemorrhoid ligation, two or more, without imaging2026 Medicare rate & RVUs in New Mexico
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization.
In New Mexico, Medicare pays $370.45 for 46946 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 46946 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 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.
How New Mexico compares for 46946
Across 109 of 109 payment localities, the facility rate for 46946 runs from $342.64 in Arkansas to $484.45 in San Benito County, CA. New Mexico pays $370.45. The RVUs are the same everywhere; the geographic indexes change the dollars.
- New Mexico · this page$370.45
- Los Angeles, CA · California$421.57+$51.12
- Washington, DC area · District of Columbia$432.45+$62.00
- Miami, FL · Florida$426.80+$56.35
- Chicago, IL · Illinois$414.86+$44.41
- Manhattan, NY · New York$441.07+$70.62
- Alaska · Alaska$461.00+$90.55
Other areas in New Mexico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $347.22 |
| ArkansasArkansas | — | $342.64 |
| ArizonaArizona | — | $373.90 |
| Bakersfield, CACalifornia | — | $398.43 |
| Chico, CACalifornia | — | $396.50 |
| El Centro, CACalifornia | — | $396.61 |
| Fresno, CACalifornia | — | $396.50 |
| Hanford, CACalifornia | — | $396.50 |
| Madera, CACalifornia | — | $396.50 |
| Merced, CACalifornia | — | $396.50 |
| Modesto, CACalifornia | — | $396.50 |
| Napa, CACalifornia | — | $450.30 |
| Oxnard, CACalifornia | — | $418.53 |
| Redding, CACalifornia | — | $396.50 |
| Rest of CaliforniaCalifornia | — | $396.50 |
| Riverside, CACalifornia | — | $403.74 |
| Sacramento, CACalifornia | — | $413.68 |
| Salinas, CACalifornia | — | $412.09 |
| San Diego, CACalifornia | — | $420.02 |
| Marin County, CACalifornia | — | $473.65 |
| San Francisco, CACalifornia | — | $472.89 |
| San Benito County, CACalifornia | — | $484.45 |
| Santa Clara County, CACalifornia | — | $481.34 |
| San Luis Obispo, CACalifornia | — | $405.74 |
| Santa Cruz, CACalifornia | — | $422.65 |
| Santa Maria, CACalifornia | — | $413.15 |
| Santa Rosa, CACalifornia | — | $426.76 |
| Stockton, CACalifornia | — | $396.50 |
| Vallejo, CACalifornia | — | $449.20 |
| Visalia, CACalifornia | — | $396.50 |
| Yuba City, CACalifornia | — | $396.50 |
| ColoradoColorado | — | $394.38 |
| ConnecticutConnecticut | — | $407.95 |
| DelawareDelaware | — | $379.67 |
| Fort Lauderdale, FLFlorida | — | $404.65 |
| Rest of FloridaFlorida | — | $385.58 |
| Atlanta, GAGeorgia | — | $392.15 |
| Rest of GeorgiaGeorgia | — | $364.88 |
| Hawaii, Guam, HIHawaii | — | $403.78 |
| IowaIowa | — | $352.03 |
| IdahoIdaho | — | $354.80 |
| East St. Louis, ILIllinois | — | $389.29 |
| Rest of IllinoisIllinois | — | $377.69 |
| Suburban Chicago, ILIllinois | — | $407.88 |
| IndianaIndiana | — | $356.60 |
| KansasKansas | — | $352.06 |
| KentuckyKentucky | — | $358.03 |
| New Orleans, LALouisiana | — | $374.15 |
| Rest of LouisianaLouisiana | — | $358.14 |
| Metropolitan Boston, MAMassachusetts | — | $428.99 |
| Rest of MassachusettsMassachusetts | — | $392.96 |
| Baltimore area, MDMaryland | — | $407.10 |
| Rest of MarylandMaryland | — | $385.98 |
| Rest of MaineMaine | — | $358.14 |
| Southern Maine, MEMaine | — | $373.59 |
| Detroit, MIMichigan | — | $391.61 |
| Rest of MichiganMichigan | — | $367.98 |
| MinnesotaMinnesota | — | $374.25 |
| Metropolitan Kansas City, MOMissouri | — | $370.16 |
| Metropolitan St. Louis, MOMissouri | — | $373.51 |
| Rest of MissouriMissouri | — | $353.56 |
| MississippiMississippi | — | $348.08 |
| MontanaMontana | — | $383.73 |
| North CarolinaNorth Carolina | — | $361.31 |
| North DakotaNorth Dakota | — | $370.48 |
| NebraskaNebraska | — | $353.32 |
| New HampshireNew Hampshire | — | $389.78 |
| Northern New JerseyNew Jersey | — | $428.90 |
| Rest of New JerseyNew Jersey | — | $411.57 |
| NevadaNevada | — | $380.25 |
| NYC suburbs and Long Island, NYNew York | — | $452.93 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $415.48 |
| Queens, NYNew York | — | $442.14 |
| Rest of New YorkNew York | — | $366.39 |
| OhioOhio | — | $365.27 |
| OklahomaOklahoma | — | $355.81 |
| Portland, OROregon | — | $404.23 |
| Rest of OregonOregon | — | $376.27 |
| Metropolitan Philadelphia, PAPennsylvania | — | $399.54 |
| Rest of PennsylvaniaPennsylvania | — | $364.93 |
| Puerto RicoPuerto Rico | — | $385.80 |
| Rhode IslandRhode Island | — | $391.23 |
| South CarolinaSouth Carolina | — | $364.10 |
| South DakotaSouth Dakota | — | $368.92 |
| TennesseeTennessee | — | $353.87 |
| Austin, TXTexas | — | $393.97 |
| Beaumont, TXTexas | — | $362.86 |
| Brazoria, TXTexas | — | $378.09 |
| Dallas, TXTexas | — | $381.06 |
| Fort Worth, TXTexas | — | $379.20 |
| Galveston, TXTexas | — | $379.60 |
| Houston, TXTexas | — | $391.86 |
| Rest of TexasTexas | — | $370.65 |
| UtahUtah | — | $368.61 |
| VirginiaVirginia | — | $373.55 |
| Virgin Islands, VIUnited States Virgin Islands | — | $385.80 |
| VermontVermont | — | $370.57 |
| Rest of WashingtonWashington | — | $391.72 |
| King County, WAWashington | — | $435.76 |
| WisconsinWisconsin | — | $359.27 |
| West VirginiaWest Virginia | — | $365.29 |
| WyomingWyoming | — | $377.96 |
46946 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.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
How the rate is built · 46946
RVUs × geographic indexes × conversion factor
Work4.39
4.39 RVUs× 1.000 GPCI
Practice expense6.43
6.43 RVUs× 1.000 GPCI
Malpractice0.67
0.67 RVUs× 1.000 GPCI
Adjusted RVUs
11.4900
Conversion factor
$33.4009
Medicare rate
$383.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact New Mexico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
5,640
- Code
- 46946
- Physician work
- 4.39
- Practice expense
- 6.43
- Malpractice
- 0.67
GPCI2026.csv
77
- Locality
- New Mexico
- Physician work
- 1.000
- Practice expense
- 0.917
- Malpractice
- 1.201
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.39 | × 1.000 | 4.3900 |
| Practice expense | 6.43 | × 0.917 | 5.8963 |
| Malpractice | 0.67 | × 1.201 | 0.8047 |
| Total RVUs | 11.0910 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, New Mexico$370.45
Facility: (4.39 × 1 + 6.43 × 0.917 + 0.67 × 1.201) × $33.4009 = $370.45
Payment rules and modifiers for 46946
46946 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46946
Hemorrhoid ligation, two or more, without imaging
| 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) | 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. |
| 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 · 46946
Hemorrhoid ligation, two or more, without imaging
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
46946 without 51 · national facility
$383.78
Hemorrhoid ligation, two or more, without imaging
46946-51 · Second procedure: 50%
$191.89
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 46946 has changed in New Mexico
46946 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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, 2020
RVU20A
$317.15changed toNo rate
Held through RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2019
RVU19A
$312.27changed to$317.15
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 5.94 changed to 6.09
- Malpractice RVU 0.46 changed to 0.45
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$308.18changed to$312.27
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 5.86 changed to 5.94
- Malpractice RVU 0.47 changed to 0.46
- Practice expense GPCI 0.920 changed to 0.921
- Malpractice GPCI 1.204 changed to 1.247
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$306.52changed to$308.18
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.919 changed to 0.920
- Malpractice GPCI 1.161 changed to 1.204
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$310.03changed to$306.52
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 5.92 changed to 5.86
- Malpractice RVU 0.48 changed to 0.47
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$308.48changed to$310.03
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$299.21changed to$308.48
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 5.74 changed to 5.92
- Malpractice RVU 0.42 changed to 0.48
- Practice expense GPCI 0.918 changed to 0.919
- Malpractice GPCI 1.079 changed to 1.161
Held through RVU15B.
January 1, 2014
RVU14A
$306.67changed to$299.21
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 6.49 changed to 5.74
- Malpractice RVU 0.44 changed to 0.42
- Practice expense GPCI 0.916 changed to 0.918
- Malpractice GPCI 0.997 changed to 1.079
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $306.67
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $370.45 | RVU26D |
| 2026-07-01 | Not available in this setting | $370.45 | RVU26C |
| 2026-04-01 | Not available in this setting | $370.45 | RVU26B |
| 2026-01-01 | Not available in this setting | $370.45 | RVU26A |
| 2025-10-01 | Not available in this setting | $359.27 | RVU25D |
| 2025-07-01 | Not available in this setting | $359.27 | RVU25C |
| 2025-04-01 | Not available in this setting | $359.27 | RVU25B |
| 2025-01-01 | Not available in this setting | $359.27 | RVU25A |
| 2024-10-01 | Not available in this setting | $367.00 | RVU24D |
| 2024-07-01 | Not available in this setting | $367.00 | RVU24C |
| 2024-04-01 | Not available in this setting | $367.00 | RVU24B |
| 2024-03-09 | Not available in this setting | $367.00 | RVU24AR |
| 2024-01-01 | Not available in this setting | $361.01 | RVU24A |
| 2023-10-01 | Not available in this setting | $370.83 | RVU23D |
| 2023-07-01 | Not available in this setting | $370.83 | RVU23C |
| 2023-04-01 | Not available in this setting | $370.83 | RVU23B |
| 2023-01-01 | Not available in this setting | $370.83 | RVU23A |
| 2022-10-01 | Not available in this setting | $378.05 | RVU22D |
| 2022-07-01 | Not available in this setting | $378.05 | RVU22C |
| 2022-04-01 | Not available in this setting | $378.05 | RVU22B |
| 2022-01-01 | Not available in this setting | $378.05 | RVU22A |
| 2021-10-01 | Not available in this setting | $377.24 | RVU21D |
| 2021-07-01 | Not available in this setting | $377.24 | RVU21C |
| 2021-04-01 | Not available in this setting | $377.24 | RVU21B |
| 2021-01-01 | Not available in this setting | $377.24 | RVU21A |
| 2020-10-01 | Not available in this setting | $378.80 | RVU20D |
| 2020-07-01 | Not available in this setting | $378.80 | RVU20C |
| 2020-04-01 | Not available in this setting | $378.80 | RVU20B |
| 2020-01-01 | Not available in this setting | $378.80 | RVU20A |
| 2019-10-01 | $317.15 | $228.52 | RVU19D |
| 2019-07-01 | $317.15 | $228.52 | RVU19C |
| 2019-04-01 | $317.15 | $228.52 | RVU19B |
| 2019-01-01 | $317.15 | $228.52 | RVU19A |
| 2018-10-01 | $312.27 | $228.39 | RVU18D |
| 2018-07-01 | $312.27 | $228.39 | RVU18C |
| 2018-04-01 | $312.27 | $228.39 | RVU18B |
| 2018-01-01 | $312.27 | $228.39 | RVU18AR1 |
| 2017-10-01 | $308.18 | $226.30 | RVU17D |
| 2017-07-01 | $308.18 | $226.30 | RVU17C |
| 2017-04-01 | $308.18 | $226.30 | RVU17B |
| 2017-01-01 | $308.18 | $226.30 | RVU17A |
| 2016-10-01 | $306.52 | $224.92 | RVU16D |
| 2016-07-01 | $306.52 | $224.92 | RVU16C |
| 2016-04-01 | $306.52 | $224.92 | RVU16B |
| 2016-01-01 | $306.52 | $224.92 | RVU16A |
| 2015-10-01 | $310.03 | $227.14 | RVU15D |
| 2015-07-01 | $310.03 | $227.14 | RVU15C |
| 2015-04-01 | $308.48 | $226.01 | RVU15B |
| 2015-01-01 | $308.48 | $226.01 | RVU15A |
| 2014-10-01 | $299.21 | $219.96 | RVU14D |
| 2014-07-01 | $299.21 | $219.96 | RVU14C |
| 2014-04-01 | $299.21 | $219.96 | RVU14B |
| 2014-01-01 | $299.21 | $219.96 | RVU14A |
| 2013-10-01 | $306.67 | $220.96 | RVU13D |
| 2013-07-01 | $306.67 | $220.96 | RVU13C |
| 2013-04-01 | $306.67 | $220.96 | RVU13B |
| 2013-01-01 | $306.67 | $220.96 | RVU13AR |
Where the New Mexico rate applies
New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.
- Abeytas
- Abiquiu
- Acomita Lake
- Adelino
- Agua Fria
- Alamillo
- Alamo
- Alamogordo
46946 billing questions
When should I report this instead of 46945?
Report 46946 when at least two internal hemorrhoids are ligated in the procedure. Code 46945 is for treatment of a single hemorrhoid.
How does this differ from rubber-band ligation?
This code represents surgical ligation other than rubber-band ligation. Do not select it solely because multiple hemorrhoids were treated with office banding.
Is modifier 50 appropriate when hemorrhoids are on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What if another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid 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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