Billing code 46221: Hemorrhoid ligationMedicare rate & RVUs
Reports office or facility treatment of internal hemorrhoids by placing rubber bands around hemorrhoidal tissue to reduce its blood supply.
Medicare pays $325.66 for 46221 nationally in the office and $197.07 in a hospital or facility. Local office rates run $286.44–$433.20.
Medicare rate · 46221
Hemorrhoid ligation
Swap in your local Medicare rate.
- Work RVUs
- 2.3
- Total RVUs
- 9.75
- Global days
- 010
National rate · 2026
$325.66
Office setting, before claim adjustments.
See every locality for 46221 → · 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 46221 covers
This procedure treats internal hemorrhoids by placing a tight rubber band around the base of hemorrhoidal tissue, typically with an anoscope for visualization. Colorectal surgeons, general surgeons, and gastroenterologists commonly perform it in an outpatient office or facility for symptomatic internal hemorrhoids, such as those causing bleeding or prolapse. The service is for ligation by rubber band, not removal of external hemorrhoids or excision of hemorrhoidal tissue.
Report 46221 for the band-ligation service, including when more than one internal hemorrhoid is treated in the session; document the indication, internal site, technique, and treated tissue. Related postoperative visits for 10 days are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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-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 46221 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
$286.44 to $433.20
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $290.84 | $178.32 |
| Alaska* | $374.06 | $237.11 |
| Arizona | $316.59 | $191.98 |
| Arkansas | $286.44 | $175.97 |
| Atlanta | $332.10 | $201.44 |
| Austin | $338.18 | $202.12 |
| Bakersfield | $345.15 | $204.21 |
| Baltimore/Surr. Cntys | $347.02 | $209.04 |
| Beaumont | $303.49 | $186.47 |
| Brazoria | $321.50 | $194.06 |
| Chicago | $342.95 | $213.72 |
| Chico | $344.12 | $203.18 |
| Colorado | $339.10 | $202.28 |
| Connecticut | $347.95 | $209.46 |
| Dallas | $323.70 | $195.62 |
| Dc + Md/Va Suburbs | $373.32 | $221.84 |
| Delaware | $321.99 | $194.94 |
| Detroit | $325.62 | $201.53 |
| East St. Louis | $318.91 | $200.60 |
| El Centro | $344.18 | $203.24 |
| Fort Lauderdale | $338.45 | $208.19 |
| Fort Worth | $321.48 | $194.69 |
| Fresno | $344.12 | $203.18 |
| Galveston | $322.55 | $194.85 |
| Hanford-Corcoran | $344.12 | $203.18 |
| Hawaii, Guam | $353.04 | $206.83 |
| Houston | $329.14 | $201.44 |
| Idaho | $300.38 | $182.07 |
| Indiana | $302.19 | $182.98 |
| Iowa | $298.28 | $180.62 |
| Kansas | $296.96 | $180.71 |
| Kentucky | $298.35 | $184.03 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $368.10 | $215.98 |
| Madera | $344.12 | $203.18 |
| Manhattan | $375.99 | $226.56 |
| Merced | $344.12 | $203.18 |
| Metropolitan Boston | $373.43 | $219.89 |
| Metropolitan Kansas City | $310.94 | $190.19 |
| Metropolitan Philadelphia | $339.07 | $205.21 |
| Metropolitan St. Louis | $314.32 | $191.89 |
| Miami | $353.75 | $219.89 |
| Minnesota | $324.06 | $191.74 |
| Mississippi | $289.60 | $178.88 |
| Modesto | $344.12 | $203.18 |
| Montana** | $325.63 | $197.04 |
| Napa | $399.89 | $230.40 |
| Nebraska | $299.95 | $181.25 |
| Nevada** | $323.89 | $195.17 |
| New Hampshire | $333.87 | $200.00 |
| New Mexico | $308.42 | $190.50 |
| New Orleans | $313.32 | $192.32 |
| North Carolina | $305.45 | $185.47 |
| North Dakota** | $318.52 | $189.92 |
| Northern Nj | $369.21 | $220.04 |
| Nyc Suburbs/Long Island | $385.64 | $232.74 |
| Ohio | $305.15 | $187.75 |
| Oklahoma | $297.64 | $182.80 |
| Oxnard-Thousand Oaks-Ventura | $366.38 | $214.38 |
| Portland | $350.10 | $207.23 |
| Poughkpsie/N Nyc Suburbs | $354.14 | $213.33 |
| Puerto Rico | $328.08 | $198.08 |
| Queens | $378.99 | $226.99 |
| Redding | $344.12 | $203.18 |
| Rest Of California | $344.12 | $203.18 |
| Rest Of Florida | $321.29 | $198.35 |
| Rest Of Georgia | $302.39 | $187.69 |
| Rest Of Illinois | $311.83 | $194.42 |
| Rest Of Louisiana | $297.92 | $184.12 |
| Rest Of Maine | $302.17 | $183.86 |
| Rest Of Maryland | $328.28 | $198.15 |
| Rest Of Massachusetts | $337.00 | $201.59 |
| Rest Of Michigan | $306.61 | $189.20 |
| Rest Of Missouri | $292.67 | $181.82 |
| Rest Of New Jersey | $351.68 | $211.26 |
| Rest Of New York | $310.25 | $188.08 |
| Rest Of Oregon | $321.14 | $193.06 |
| Rest Of Pennsylvania | $305.58 | $187.53 |
| Rest Of Texas | $312.41 | $190.38 |
| Rest Of Washington | $336.33 | $200.93 |
| Rhode Island | $333.63 | $200.80 |
| Riverside-San Bernardino-Ontario | $348.01 | $207.07 |
| Sacramento-Roseville-Folsom | $361.45 | $211.89 |
| Salinas | $360.11 | $211.07 |
| San Diego-Chula Vista-Carlsbad | $368.87 | $215.07 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $423.54 | $242.23 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $423.14 | $241.82 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $433.20 | $247.77 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $431.53 | $246.10 |
| San Luis Obispo-Paso Robles | $354.30 | $207.83 |
| Santa Cruz-Watsonville | $372.61 | $216.37 |
| Santa Maria-Santa Barbara | $361.54 | $211.60 |
| Santa Rosa-Petaluma | $376.38 | $218.46 |
| Seattle (King Cnty) | $381.06 | $223.27 |
| South Carolina | $305.86 | $187.04 |
| South Dakota** | $317.67 | $189.08 |
| Southern Maine | $319.09 | $191.65 |
| Stockton | $344.12 | $203.18 |
| Suburban Chicago | $341.87 | $209.81 |
| Tennessee | $298.54 | $181.65 |
| Utah | $310.22 | $189.35 |
| Vallejo | $399.30 | $229.81 |
| Vermont | $317.35 | $190.04 |
| Virgin Islands | $328.08 | $198.08 |
| Virginia | $318.10 | $191.69 |
| Visalia | $344.12 | $203.18 |
| West Virginia | $299.82 | $188.07 |
| Wisconsin | $307.39 | $184.20 |
| Wyoming** | $322.53 | $193.94 |
| Yuba City | $344.12 | $203.18 |
46221 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.
$286.44
$388.66
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 | $374.06 | 1 |
| AL | $290.84 | 1 |
| AR | $286.44 | 1 |
| AZ | $316.59 | 1 |
| CA | $344.12–$433.20 | 29 |
| CO | $339.10 | 1 |
| CT | $347.95 | 1 |
| DC | $373.32 | 1 |
| DE | $321.99 | 1 |
| FL | $321.29–$353.75 | 3 |
| GA | $302.39–$332.10 | 2 |
| GU | $353.04 | 1 |
| HI | $353.04 | 1 |
| IA | $298.28 | 1 |
| ID | $300.38 | 1 |
| IL | $311.83–$342.95 | 4 |
| IN | $302.19 | 1 |
| KS | $296.96 | 1 |
| KY | $298.35 | 1 |
| LA | $297.92–$313.32 | 2 |
| MA | $337.00–$373.43 | 2 |
| MD | $328.28–$373.32 | 3 |
| ME | $302.17–$319.09 | 2 |
| MI | $306.61–$325.62 | 2 |
| MN | $324.06 | 1 |
| MO | $292.67–$314.32 | 3 |
| MS | $289.60 | 1 |
| MT | $325.63 | 1 |
| NC | $305.45 | 1 |
| ND | $318.52 | 1 |
| NE | $299.95 | 1 |
| NH | $333.87 | 1 |
| NJ | $351.68–$369.21 | 2 |
| NM | $308.42 | 1 |
| NV | $323.89 | 1 |
| NY | $310.25–$385.64 | 5 |
| OH | $305.15 | 1 |
| OK | $297.64 | 1 |
| OR | $321.14–$350.10 | 2 |
| PA | $305.58–$339.07 | 2 |
| PR | $328.08 | 1 |
| RI | $333.63 | 1 |
| SC | $305.86 | 1 |
| SD | $317.67 | 1 |
| TN | $298.54 | 1 |
| TX | $303.49–$338.18 | 8 |
| UT | $310.22 | 1 |
| VA | $318.10–$373.32 | 2 |
| VI | $328.08 | 1 |
| VT | $317.35 | 1 |
| WA | $336.33–$381.06 | 2 |
| WI | $307.39 | 1 |
| WV | $299.82 | 1 |
| WY | $322.53 | 1 |
How the 46221 rate is calculated
Each of 46221’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 · 46221
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.30Practice expense 7.09Malpractice 0.36
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46221
46221 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46221
Hemorrhoid ligation
| 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 · 46221
Hemorrhoid ligation
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
46221 without 51 · national office
$325.66
Hemorrhoid ligation
46221-51 · Second procedure: 50%
$162.83
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%).
46221 compared with similar codes
Compare codes
46221 vs 46930 vs 46945 vs 46255 vs 46250: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46930Hemorrhoid treatment
- Use 46221 when internal hemorrhoidal tissue is treated with rubber bands; 46930 describes thermal destruction.
- 46945Hemorrhoid ligation
- Both treat internal hemorrhoids by ligation, but 46945 is for ligation by a method other than rubber-band ligation.
- 46255Hemorrhoidectomy
- 46221 is band ligation of internal tissue. 46255 describes excision of an internal and external hemorrhoid group.
- 46250Hemorrhoidectomy
- 46250 is excision of multiple external hemorrhoid groups; 46221 treats internal hemorrhoids by rubber-band ligation.
46221 billing questions
Does 46221 cover one band or multiple bands?
The code covers rubber-band ligation of internal hemorrhoid tissue, including when multiple sites are treated in the session. Document the treated internal tissue and technique rather than reporting a separate unit for each band.
How is this different from excisional hemorrhoidectomy?
46221 describes rubber-band ligation of internal hemorrhoids. Codes such as 46255 and 46260 describe excision, with the applicable code depending on the tissue and extent removed.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in 46221.
Can modifier 50 be used when hemorrhoids are treated on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
How does Medicare handle other procedures performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be billed for the ligation?
Medicare does not pay an assistant at surgery for 46221. Co-surgeon and team-surgery billing 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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