Billing code 46220: Anal tag excisionMedicare rate & RVUs
Reports excision of one external anal skin tag or papilla when the treated tissue is a tag rather than hemorrhoidal disease.
Medicare pays $275.56 for 46220 nationally in the office and $119.58 in a hospital or facility. Local office rates run $240.77–$371.17.
Medicare rate · 46220
Anal tag excision
Swap in your local Medicare rate.
- Work RVUs
- 1.57
- Total RVUs
- 8.25
- Global days
- 010
National rate · 2026
$275.56
Office setting, before claim adjustments.
See every locality for 46220 → · Billed by an NP, PA or therapist? →
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 10 sections
What 46220 covers
A clinician removes one external anal skin tag or hypertrophied anal papilla, typically to address irritation, hygiene difficulty, or discomfort. Colorectal and general surgeons commonly perform the procedure in an office or outpatient setting, with the site examined and the lesion excised. The operative note should identify the external lesion and document that one tag or papilla was removed, rather than describing treatment of hemorrhoids or an anal fissure.
Report this code for a single external tag; use the multiple-tag code when more than one is excised. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 46220 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$240.77 to $371.17
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $244.67 | $108.19 |
| Alaska* | $311.30 | $145.18 |
| Arizona | $267.55 | $116.40 |
| Arkansas | $240.77 | $106.78 |
| Atlanta | $281.08 | $122.60 |
| Austin | $286.94 | $121.91 |
| Bakersfield | $293.26 | $122.30 |
| Baltimore/Surr. Cntys | $294.27 | $126.90 |
| Beaumont | $255.66 | $113.72 |
| Brazoria | $271.93 | $117.35 |
| Chicago | $289.54 | $132.77 |
| Chico | $292.44 | $121.49 |
| Colorado | $287.73 | $121.76 |
| Connecticut | $295.07 | $127.08 |
| Dallas | $273.80 | $118.44 |
| Dc + Md/Va Suburbs | $317.47 | $133.73 |
| Delaware | $272.28 | $118.17 |
| Detroit | $274.73 | $124.21 |
| East St. Louis | $268.30 | $124.80 |
| El Centro | $292.49 | $121.54 |
| Fort Lauderdale | $286.16 | $128.15 |
| Fort Worth | $271.79 | $117.99 |
| Fresno | $292.44 | $121.49 |
| Galveston | $272.82 | $117.93 |
| Hanford-Corcoran | $292.44 | $121.49 |
| Hawaii, Guam | $300.72 | $123.37 |
| Houston | $278.12 | $123.23 |
| Idaho | $253.38 | $109.87 |
| Indiana | $255.00 | $110.40 |
| Iowa | $251.57 | $108.85 |
| Kansas | $250.26 | $109.26 |
| Kentucky | $251.04 | $112.37 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $313.51 | $128.98 |
| Madera | $292.44 | $121.49 |
| Manhattan | $319.17 | $137.91 |
| Merced | $292.44 | $121.49 |
| Metropolitan Boston | $318.05 | $131.80 |
| Metropolitan Kansas City | $262.32 | $115.85 |
| Metropolitan Philadelphia | $287.12 | $124.74 |
| Metropolitan St. Louis | $265.33 | $116.84 |
| Miami | $299.12 | $136.74 |
| Minnesota | $274.93 | $114.42 |
| Mississippi | $243.36 | $109.06 |
| Modesto | $292.44 | $121.49 |
| Montana** | $275.54 | $119.56 |
| Napa | $341.97 | $136.38 |
| Nebraska | $253.10 | $109.13 |
| Nevada** | $274.15 | $118.02 |
| New Hampshire | $283.10 | $120.72 |
| New Mexico | $259.79 | $116.75 |
| New Orleans | $264.28 | $117.50 |
| North Carolina | $257.76 | $112.23 |
| North Dakota** | $269.80 | $113.82 |
| Northern Nj | $313.67 | $132.73 |
| Nyc Suburbs/Long Island | $327.55 | $142.09 |
| Ohio | $257.07 | $114.65 |
| Oklahoma | $250.56 | $111.27 |
| Oxnard-Thousand Oaks-Ventura | $312.22 | $127.85 |
| Portland | $297.61 | $124.31 |
| Poughkpsie/N Nyc Suburbs | $300.23 | $129.43 |
| Puerto Rico | $277.76 | $120.06 |
| Queens | $322.04 | $137.67 |
| Redding | $292.44 | $121.49 |
| Rest Of California | $292.44 | $121.49 |
| Rest Of Florida | $271.04 | $121.92 |
| Rest Of Georgia | $254.37 | $115.23 |
| Rest Of Illinois | $262.44 | $120.03 |
| Rest Of Louisiana | $250.61 | $112.56 |
| Rest Of Maine | $254.82 | $111.32 |
| Rest Of Maryland | $277.85 | $119.99 |
| Rest Of Massachusetts | $285.74 | $121.49 |
| Rest Of Michigan | $258.24 | $115.83 |
| Rest Of Missouri | $245.85 | $111.40 |
| Rest Of New Jersey | $298.23 | $127.90 |
| Rest Of New York | $262.01 | $113.83 |
| Rest Of Oregon | $271.83 | $116.47 |
| Rest Of Pennsylvania | $257.52 | $114.33 |
| Rest Of Texas | $263.73 | $115.71 |
| Rest Of Washington | $285.24 | $120.99 |
| Rhode Island | $282.55 | $121.42 |
| Riverside-San Bernardino-Ontario | $295.57 | $124.61 |
| Sacramento-Roseville-Folsom | $307.74 | $126.33 |
| Salinas | $306.62 | $125.84 |
| San Diego-Chula Vista-Carlsbad | $314.53 | $127.97 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $362.81 | $142.87 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $362.48 | $142.54 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $371.17 | $146.24 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $369.82 | $144.90 |
| San Luis Obispo-Paso Robles | $301.62 | $123.96 |
| Santa Cruz-Watsonville | $318.05 | $128.53 |
| Santa Maria-Santa Barbara | $307.96 | $126.09 |
| Santa Rosa-Petaluma | $321.30 | $129.75 |
| Seattle (King Cnty) | $324.86 | $133.47 |
| South Carolina | $257.88 | $113.76 |
| South Dakota** | $269.13 | $113.14 |
| Southern Maine | $270.06 | $115.48 |
| Stockton | $292.44 | $121.49 |
| Suburban Chicago | $289.16 | $128.97 |
| Tennessee | $251.65 | $109.86 |
| Utah | $261.76 | $115.14 |
| Vallejo | $341.49 | $135.91 |
| Vermont | $268.64 | $114.22 |
| Virgin Islands | $277.76 | $120.06 |
| Virginia | $269.08 | $115.75 |
| Visalia | $292.44 | $121.49 |
| West Virginia | $251.77 | $116.22 |
| Wisconsin | $259.89 | $110.46 |
| Wyoming** | $273.04 | $117.06 |
| Yuba City | $292.44 | $121.49 |
46220 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.
$240.77
$331.81
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 | $311.30 | 1 |
| AL | $244.67 | 1 |
| AR | $240.77 | 1 |
| AZ | $267.55 | 1 |
| CA | $292.44–$371.17 | 29 |
| CO | $287.73 | 1 |
| CT | $295.07 | 1 |
| DC | $317.47 | 1 |
| DE | $272.28 | 1 |
| FL | $271.04–$299.12 | 3 |
| GA | $254.37–$281.08 | 2 |
| GU | $300.72 | 1 |
| HI | $300.72 | 1 |
| IA | $251.57 | 1 |
| ID | $253.38 | 1 |
| IL | $262.44–$289.54 | 4 |
| IN | $255.00 | 1 |
| KS | $250.26 | 1 |
| KY | $251.04 | 1 |
| LA | $250.61–$264.28 | 2 |
| MA | $285.74–$318.05 | 2 |
| MD | $277.85–$317.47 | 3 |
| ME | $254.82–$270.06 | 2 |
| MI | $258.24–$274.73 | 2 |
| MN | $274.93 | 1 |
| MO | $245.85–$265.33 | 3 |
| MS | $243.36 | 1 |
| MT | $275.54 | 1 |
| NC | $257.76 | 1 |
| ND | $269.80 | 1 |
| NE | $253.10 | 1 |
| NH | $283.10 | 1 |
| NJ | $298.23–$313.67 | 2 |
| NM | $259.79 | 1 |
| NV | $274.15 | 1 |
| NY | $262.01–$327.55 | 5 |
| OH | $257.07 | 1 |
| OK | $250.56 | 1 |
| OR | $271.83–$297.61 | 2 |
| PA | $257.52–$287.12 | 2 |
| PR | $277.76 | 1 |
| RI | $282.55 | 1 |
| SC | $257.88 | 1 |
| SD | $269.13 | 1 |
| TN | $251.65 | 1 |
| TX | $255.66–$286.94 | 8 |
| UT | $261.76 | 1 |
| VA | $269.08–$317.47 | 2 |
| VI | $277.76 | 1 |
| VT | $268.64 | 1 |
| WA | $285.24–$324.86 | 2 |
| WI | $259.89 | 1 |
| WV | $251.77 | 1 |
| WY | $273.04 | 1 |
How the 46220 rate is calculated
Each of 46220’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 · 46220
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.57Practice expense 6.39Malpractice 0.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46220
46220 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46220
Anal tag excision
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46220
Anal tag excision
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46220 without 51 · national office
$275.56
Anal tag excision
46220-51 · Second procedure: 50%
$137.78
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%).
46220 compared with similar codes
Compare codes
46220 vs 46230 vs 46221 vs 46250: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46230Anal tag excision
- 46220 is for one external tag or papilla; 46230 is for multiple external tags.
- 46221Hemorrhoid ligation
- 46221 treats hemorrhoids by ligation. Choose 46220 only when the excised lesion is an external tag or papilla.
- 46250Hemorrhoidectomy
- 46250 is hemorrhoidectomy for multiple external hemorrhoid groups; 46220 is for a single external tag or papilla.
46220 billing questions
When should this code be chosen over 46230?
Use this code when one external anal tag or papilla is excised. Use 46230 when multiple external tags are removed.
Can this code be reported for hemorrhoid removal?
No. It describes excision of an external tag or papilla, not hemorrhoidal tissue. Select the hemorrhoid procedure that matches the documented disease and operative treatment.
Are related postoperative visits separately reported?
Visits related to the procedure during its 10-day global period are included.
Should modifier 50 be appended for tags on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does Medicare handle another procedure performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service, and 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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