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Billing code 46261: HemorrhoidectomyMedicare rate & RVUs

Reports excision of internal and external hemorrhoidal disease in two or more groups when an anal fissure is also excised during the operation.

CMS RVU26DEffective Oct 1, 2026109 payment localities185 Medicare services in 2024

Medicare pays $515.38 for 46261 nationally in a facility.

Medicare rate · 46261

Hemorrhoidectomy

Swap in your local Medicare rate.

Work RVUs
7.57
Total RVUs
15.43
Global days
090

National rate · 2026

$515.38

Facility setting, before claim adjustments.

See every locality for 46261 → · 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 46261 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 46261 covers

Code 46261 represents excision of internal and external hemorrhoidal disease involving two or more columns or groups, performed with excision of an anal fissure. A colorectal or general surgeon typically performs the operation in an operating room for symptomatic hemorrhoids requiring excision when a fissure is also treated surgically.

Report it when the operative record supports both the multiple-group hemorrhoidectomy and fissurectomy; document the number of groups and the fissure treatment. The fissurectomy is part of this combined service, so do not separately report 46200 for that same fissure. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one 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; 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 46261 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

46261 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$467.70
Alaska*Unavailable$634.14
ArizonaUnavailable$501.80
ArkansasUnavailable$461.81
AtlantaUnavailable$529.23
AustinUnavailable$522.84
BakersfieldUnavailable$521.96
Baltimore/Surr. CntysUnavailable$546.47
BeaumontUnavailable$492.66
BrazoriaUnavailable$504.89

46261 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
46261 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 46261 rate is calculated

Each of 46261’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 · 46261

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.57Practice expense 6.42Malpractice 1.44

15.4300 adjusted RVUs×$33.4009 conversion factor=$515.38

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 46261

46261 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46261

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)1Not paid (statutory restriction).
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 · 46261

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

46261 without 51 · national facility

$515.38

Hemorrhoidectomy

46261-51 · Second procedure: 50%

$257.69

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

46261 compared with similar codes

Compare codes

46261 vs 46257 vs 46260 vs 46262 vs 46200: national Medicare rates

Swap in your local Medicare rate.

  • 46261
    Hemorrhoidectomy · 7.57 wRVU
    —
  • 46257
    Hemorrhoidectomy · 5.62 wRVU
    —
  • 46260
    Hemorrhoidectomy · 6.56 wRVU
    —
  • 46262
    Hemorrhoidectomy · 7.71 wRVU
    —
  • 46200
    Fissure surgery · 3.5 wRVU
    $530.74

How to choose

46257Hemorrhoidectomy
Both include fissurectomy, but 46257 applies to one hemorrhoidal group. 46261 requires two or more groups.
46260Hemorrhoidectomy
Both cover internal and external hemorrhoidectomy involving two or more groups. 46261 also includes fissurectomy; 46260 does not.
46262Hemorrhoidectomy
This code pairs the multiple-group hemorrhoidectomy with fistulectomy. 46261 pairs it with fissurectomy.
46200Fissure surgery
46200 is for fissure excision without the combined multiple-group hemorrhoidectomy reported by 46261.

Codes related to 46261

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

Codes related to 46261
CodeHow it relatesNational office range
Same family
46257HemorrhoidectomyCombined hemorrhoidectomy and fissurectomy for one hemorrhoidal group.No office rate
46260HemorrhoidectomyHemorrhoidectomy for two or more groups without fissurectomy.No office rate
46262HemorrhoidectomyHemorrhoidectomy for two or more groups with fistulectomy instead of fissurectomy.No office rate
46255HemorrhoidectomyInternal and external hemorrhoidectomy for one group without fissurectomy.$511.28–$756.36
Used instead
46200Fissure surgeryFissure excision without the multiple-group hemorrhoidectomy.$465.50–$708.36

46261 billing questions

How does 46261 differ from 46257?

Both include hemorrhoidectomy with fissurectomy. Use 46261 for two or more hemorrhoidal groups; 46257 is for one group.

Can the fissurectomy also be reported as 46200?

Do not separately report 46200 for the fissure excised as part of the 46261 operation.

When is 46260 a better choice?

Use 46260 for internal and external hemorrhoidectomy involving two or more groups when the operation does not include fissurectomy.

Should modifier 50 be appended?

No. CMS identifies bilateral adjustment as inappropriate for this code.

What documentation supports 46261?

The operative note should describe internal and external hemorrhoidal disease, the two-or-more group extent, and the fissure excision.

How are other procedures in the same session paid?

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
RVUs for 46261PPRRVU2026_Oct_nonQPP.csv, line 5,588 (RVU26D)

Open CMS sourceHow we calculate rates

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