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Billing code 46258: HemorrhoidectomyMedicare rate & RVUs

Reports excision of one internal and external hemorrhoid group together with fistulectomy during the same operative session.

CMS RVU26DEffective Oct 1, 2026109 payment localities44 Medicare services in 2024

Medicare pays $480.97 for 46258 nationally in a facility.

Medicare rate · 46258

Hemorrhoidectomy

Work RVUs
6.25
Total RVUs
14.40
Global days
090

National rate · 2026

$480.97

Facility setting, before claim adjustments.

See every locality for 46258 →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
  1. Medicare rate
  2. What 46258 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 46258 covers

This service combines excision of one internal and external hemorrhoid group with surgical removal of an anal fistula. It is typically performed by a colorectal surgeon or general surgeon in an operating room or ambulatory surgery center when both conditions are treated in the same operation. The hemorrhoid component is limited to one column or group; the fistulectomy is part of the service described by this code.

Select this code when the operative report supports treatment of one hemorrhoid group and fistulectomy, rather than fissurectomy or treatment of multiple groups. Document the hemorrhoid site and extent, the fistula treated, and the procedures actually performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and additional procedures at 50%. Modifier 50 is inappropriate for this single-group service. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment 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 46258 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

46258 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$429.71
Alaska*Unavailable$574.37
ArizonaUnavailable$466.23
ArkansasUnavailable$423.40
AtlantaUnavailable$496.27
AustinUnavailable$487.59
BakersfieldUnavailable$483.91
Baltimore/Surr. CntysUnavailable$513.33
BeaumontUnavailable$457.53
BrazoriaUnavailable$468.42

46258 rates by state

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

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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
46258 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 46258 rate is calculated

Each of 46258’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 · 46258

RVUs × geographic indexes × conversion factor

Work6.25

6.25 RVUs× 1.000 GPCI

Practice expense6.48

6.48 RVUs× 1.000 GPCI

Malpractice1.67

1.67 RVUs× 1.000 GPCI

Adjusted RVUs

14.4000

Conversion factor

$33.4009

Medicare rate

$480.97

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 46258

46258 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46258

Hemorrhoidectomy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 46258

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

46258 without 51 · national facility

$480.97

Hemorrhoidectomy

46258-51 · Second procedure: 50%

$240.49

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%).

When to use modifier 51

46258 compared with similar codes

Compare codes · National

5 codes, side by side

  • 46258

    Hemorrhoidectomy6.25 wRVU

    Not priced

  • 46255

    Hemorrhoidectomy4.84 wRVU

    $580.84

  • 46257

    Hemorrhoidectomy5.62 wRVU

    Not priced

  • 46262

    Hemorrhoidectomy7.71 wRVU

    Not priced

  • 46270

    Anal fistula surgery4.8 wRVU

    $599.88

How to choose

46255Hemorrhoidectomy
Choose 46255 for excision of one internal and external hemorrhoid group without fistulectomy. The fistulectomy is the distinguishing work in 46258.
46257Hemorrhoidectomy
46257 combines single-group hemorrhoidectomy with fissurectomy. 46258 combines it with fistulectomy.
46262Hemorrhoidectomy
Both include fistulectomy, but 46262 is for removal of two or more internal and external hemorrhoid groups; 46258 is for one.
46270Anal fistula surgery
46270 covers fistulectomy for a subcutaneous fistula without the combined single-group hemorrhoidectomy reported by 46258.

Codes related to 46258

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

Codes related to 46258
CodeHow it relatesNational office range
Same family
46255HemorrhoidectomySingle-group internal and external hemorrhoidectomy without the fistulectomy included here.$511.28–$756.36
46257HemorrhoidectomySingle-group hemorrhoidectomy paired with fissurectomy rather than fistulectomy.No office rate
46260HemorrhoidectomyInternal and external hemorrhoidectomy for two or more groups without fistulectomy.No office rate
46262HemorrhoidectomyHemorrhoidectomy with fistulectomy when two or more groups are treated.No office rate
Used instead
46270Anal fistula surgeryFistulectomy for a subcutaneous fistula without the combined hemorrhoidectomy service.$526.53–$781.84

46258 billing questions

How does this differ from 46255?

46258 includes fistulectomy with removal of one internal and external hemorrhoid group. Use 46255 when that group is removed without fistulectomy.

When is 46257 a better fit?

46257 pairs single-group hemorrhoidectomy with fissurectomy. This code is for the combination with fistulectomy instead.

How many hemorrhoid groups does this code cover?

It describes one internal and external hemorrhoid column or group. When two or more groups are removed with fistulectomy, compare 46262.

What should the operative note support?

Document the single hemorrhoid group excised, the fistula treated, and the operative work performed. The record should make clear that fistulectomy occurred during the same session.

Can an assistant surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery payment are not permitted for this service.

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
RVUs for 46258PPRRVU2026_Oct_nonQPP.csv, line 5,586 (RVU26D)

Open CMS sourceHow we calculate rates

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