Billing code 46250: HemorrhoidectomyMedicare rate & RVUs
Reports excisional surgery for external hemorrhoids involving two or more groups, rather than a single group or internal-and-external disease.
Medicare pays $536.75 for 46250 nationally in the office and $318.64 in a hospital or facility. Local office rates run $470.92–$702.67.
Medicare rate · 46250
Hemorrhoidectomy
Swap in your local Medicare rate.
- Work RVUs
- 4.14
- Total RVUs
- 16.07
- Global days
- 090
National rate · 2026
$536.75
Office setting, before claim adjustments.
See every locality for 46250 → · 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 46250 covers
This code describes operative excision of external hemorrhoids in two or more groups. It is typically performed by a colorectal or general surgeon for symptomatic external hemorrhoidal disease requiring removal, often in a surgical facility. The operative report should identify the external disease treated and document excision involving multiple groups; a procedure limited to anal tags or to hemorrhoid ligation is a different service.
Report the code once for the qualifying excision, not once per group. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. If 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 for this code. 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 46250 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
$470.92 to $702.67
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $478.27 | $287.43 |
| Alaska* | $617.37 | $385.09 |
| Arizona | $521.23 | $309.88 |
| Arkansas | $470.92 | $283.56 |
| Atlanta | $548.73 | $327.14 |
| Austin | $555.31 | $324.56 |
| Bakersfield | $563.97 | $324.92 |
| Baltimore/Surr. Cntys | $572.65 | $338.63 |
| Beaumont | $501.42 | $302.94 |
| Brazoria | $528.35 | $312.21 |
| Chicago | $575.91 | $356.71 |
| Chico | $561.64 | $322.60 |
| Colorado | $555.97 | $323.91 |
| Connecticut | $573.93 | $339.03 |
| Dallas | $532.53 | $315.30 |
| Dc + Md/Va Suburbs | $613.32 | $356.39 |
| Delaware | $530.17 | $314.67 |
| Detroit | $543.03 | $332.56 |
| East St. Louis | $535.57 | $334.91 |
| El Centro | $561.79 | $322.74 |
| Fort Lauderdale | $564.24 | $343.29 |
| Fort Worth | $529.19 | $314.14 |
| Fresno | $561.64 | $322.60 |
| Galveston | $530.44 | $313.86 |
| Hanford-Corcoran | $561.64 | $322.60 |
| Hawaii, Guam | $575.69 | $327.70 |
| Houston | $545.82 | $329.23 |
| Idaho | $492.33 | $291.67 |
| Indiana | $495.29 | $293.10 |
| Iowa | $488.35 | $288.78 |
| Kansas | $487.28 | $290.11 |
| Kentucky | $493.25 | $299.35 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $600.78 | $342.76 |
| Madera | $561.64 | $322.60 |
| Manhattan | $622.05 | $368.61 |
| Merced | $561.64 | $322.60 |
| Metropolitan Boston | $611.20 | $350.78 |
| Metropolitan Kansas City | $513.51 | $308.71 |
| Metropolitan Philadelphia | $559.84 | $332.79 |
| Metropolitan St. Louis | $519.03 | $311.39 |
| Miami | $594.84 | $367.79 |
| Minnesota | $527.74 | $303.31 |
| Mississippi | $477.94 | $290.15 |
| Modesto | $561.64 | $322.60 |
| Montana** | $536.70 | $318.59 |
| Napa | $649.45 | $361.99 |
| Nebraska | $490.78 | $289.47 |
| Nevada** | $532.44 | $314.11 |
| New Hampshire | $548.43 | $321.38 |
| New Mexico | $511.65 | $311.64 |
| New Orleans | $518.71 | $313.47 |
| North Carolina | $501.81 | $298.31 |
| North Dakota** | $520.09 | $301.98 |
| Northern Nj | $606.64 | $353.63 |
| Nyc Suburbs/Long Island | $639.66 | $380.33 |
| Ohio | $504.75 | $305.62 |
| Oklahoma | $490.86 | $296.09 |
| Oxnard-Thousand Oaks-Ventura | $597.46 | $339.66 |
| Portland | $572.90 | $330.58 |
| Poughkpsie/N Nyc Suburbs | $584.06 | $345.23 |
| Puerto Rico | $540.41 | $319.90 |
| Queens | $625.42 | $367.62 |
| Redding | $561.64 | $322.60 |
| Rest Of California | $561.64 | $322.60 |
| Rest Of Florida | $534.57 | $326.06 |
| Rest Of Georgia | $502.13 | $307.58 |
| Rest Of Illinois | $520.32 | $321.19 |
| Rest Of Louisiana | $492.98 | $299.95 |
| Rest Of Maine | $496.51 | $295.85 |
| Rest Of Maryland | $540.28 | $319.55 |
| Rest Of Massachusetts | $552.90 | $323.23 |
| Rest Of Michigan | $508.15 | $309.01 |
| Rest Of Missouri | $484.91 | $296.90 |
| Rest Of New Jersey | $579.08 | $340.91 |
| Rest Of New York | $509.90 | $302.70 |
| Rest Of Oregon | $526.94 | $309.70 |
| Rest Of Pennsylvania | $504.84 | $304.61 |
| Rest Of Texas | $515.14 | $308.16 |
| Rest Of Washington | $551.48 | $321.81 |
| Rhode Island | $548.57 | $323.27 |
| Riverside-San Bernardino-Ontario | $570.68 | $331.63 |
| Sacramento-Roseville-Folsom | $589.09 | $335.43 |
| Salinas | $586.92 | $334.13 |
| San Diego-Chula Vista-Carlsbad | $600.65 | $339.80 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $686.58 | $379.05 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $685.63 | $378.09 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $702.67 | $388.16 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $698.77 | $384.26 |
| San Luis Obispo-Paso Robles | $577.57 | $329.15 |
| Santa Cruz-Watsonville | $606.28 | $341.28 |
| Santa Maria-Santa Barbara | $589.10 | $334.78 |
| Santa Rosa-Petaluma | $612.34 | $344.50 |
| Seattle (King Cnty) | $622.62 | $355.00 |
| South Carolina | $504.39 | $302.86 |
| South Dakota** | $518.12 | $300.01 |
| Southern Maine | $523.07 | $306.92 |
| Stockton | $561.64 | $322.60 |
| Suburban Chicago | $569.38 | $345.38 |
| Tennessee | $490.05 | $291.79 |
| Utah | $511.67 | $306.64 |
| Vallejo | $648.08 | $360.61 |
| Vermont | $519.19 | $303.26 |
| Virgin Islands | $540.41 | $319.90 |
| Virginia | $522.21 | $307.81 |
| Visalia | $561.64 | $322.60 |
| West Virginia | $500.32 | $310.78 |
| Wisconsin | $501.78 | $292.83 |
| Wyoming** | $529.46 | $311.35 |
| Yuba City | $561.64 | $322.60 |
46250 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.
$470.92
$632.16
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 | $617.37 | 1 |
| AL | $478.27 | 1 |
| AR | $470.92 | 1 |
| AZ | $521.23 | 1 |
| CA | $561.64–$702.67 | 29 |
| CO | $555.97 | 1 |
| CT | $573.93 | 1 |
| DC | $613.32 | 1 |
| DE | $530.17 | 1 |
| FL | $534.57–$594.84 | 3 |
| GA | $502.13–$548.73 | 2 |
| GU | $575.69 | 1 |
| HI | $575.69 | 1 |
| IA | $488.35 | 1 |
| ID | $492.33 | 1 |
| IL | $520.32–$575.91 | 4 |
| IN | $495.29 | 1 |
| KS | $487.28 | 1 |
| KY | $493.25 | 1 |
| LA | $492.98–$518.71 | 2 |
| MA | $552.90–$611.20 | 2 |
| MD | $540.28–$613.32 | 3 |
| ME | $496.51–$523.07 | 2 |
| MI | $508.15–$543.03 | 2 |
| MN | $527.74 | 1 |
| MO | $484.91–$519.03 | 3 |
| MS | $477.94 | 1 |
| MT | $536.70 | 1 |
| NC | $501.81 | 1 |
| ND | $520.09 | 1 |
| NE | $490.78 | 1 |
| NH | $548.43 | 1 |
| NJ | $579.08–$606.64 | 2 |
| NM | $511.65 | 1 |
| NV | $532.44 | 1 |
| NY | $509.90–$639.66 | 5 |
| OH | $504.75 | 1 |
| OK | $490.86 | 1 |
| OR | $526.94–$572.90 | 2 |
| PA | $504.84–$559.84 | 2 |
| PR | $540.41 | 1 |
| RI | $548.57 | 1 |
| SC | $504.39 | 1 |
| SD | $518.12 | 1 |
| TN | $490.05 | 1 |
| TX | $501.42–$555.31 | 8 |
| UT | $511.67 | 1 |
| VA | $522.21–$613.32 | 2 |
| VI | $540.41 | 1 |
| VT | $519.19 | 1 |
| WA | $551.48–$622.62 | 2 |
| WI | $501.78 | 1 |
| WV | $500.32 | 1 |
| WY | $529.46 | 1 |
How the 46250 rate is calculated
Each of 46250’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 · 46250
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.14Practice expense 11.09Malpractice 0.84
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46250
46250 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46250
Hemorrhoidectomy
| 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 · 46250
Hemorrhoidectomy
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
46250 without 51 · national office
$536.75
Hemorrhoidectomy
46250-51 · Second procedure: 50%
$268.38
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%).
46250 compared with similar codes
Compare codes
46250 vs 46255 vs 46260 vs 46221 vs 46230: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46255Hemorrhoidectomy
- 46255 is for combined internal and external hemorrhoidectomy involving one group. This code is for external hemorrhoids involving two or more groups.
- 46260Hemorrhoidectomy
- 46260 includes excision of internal and external hemorrhoids in two or more groups; this code addresses external hemorrhoids only.
- 46221Hemorrhoid ligation
- 46221 reports hemorrhoid ligation, not excisional removal of multiple external hemorrhoid groups.
- 46230Anal tag excision
- 46230 is for excision of multiple anal tags. Use this code when the operative service is hemorrhoidectomy involving multiple external groups.
46250 billing questions
When is this code appropriate instead of 46255?
Use this code for excision of external hemorrhoids involving two or more groups. Code 46255 describes combined internal and external hemorrhoidectomy involving one group.
How does this differ from 46260?
Both describe hemorrhoidectomy involving two or more groups, but 46260 includes internal and external disease. This code is for external hemorrhoids.
Should the code be reported once for each group removed?
No. Report one unit for the qualifying excisional procedure; document that two or more external groups were treated.
Can modifier 50 be used when disease is on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code because its descriptor or anatomy makes modifier 50 unsuitable.
Are postoperative visits separately reported?
Related postoperative care during the 90-day global period is included, as is the day-before preoperative visit.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. 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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