Billing code 46320: Hemorrhoid excisionMedicare rate & RVUs
Report this service for excision of a thrombosed external hemorrhoid, typically to treat a painful, localized perianal lump.
Medicare pays $232.47 for 46320 nationally in the office and $108.22 in a hospital or facility. Local office rates run $204.01–$309.01.
Medicare rate · 46320
Hemorrhoid excision
Swap in your local Medicare rate.
- Work RVUs
- 1.6
- Total RVUs
- 6.96
- Global days
- 010
National rate · 2026
$232.47
Office setting, before claim adjustments.
See every locality for 46320 → · 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 46320 covers
The service removes a thrombosed external hemorrhoid rather than simply opening it to release the clot. It is commonly performed by a surgeon or other qualified clinician for an acutely painful, palpable perianal lump, often in an office or outpatient setting. The operative note should make clear that excision was performed and identify the treated external hemorrhoidal lesion; an incision alone is a different service.
Report 46320 when the documented procedure is excision of the thrombosed external hemorrhoid, not a broader hemorrhoidectomy involving hemorrhoidal columns. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. When other 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 for this code. 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 46320 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
$204.01 to $309.01
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $207.20 | $98.48 |
| Alaska* | $266.02 | $133.69 |
| Arizona | $225.86 | $105.46 |
| Arkansas | $204.01 | $97.28 |
| Atlanta | $237.23 | $110.99 |
| Austin | $241.35 | $109.89 |
| Bakersfield | $246.12 | $109.94 |
| Baltimore/Surr. Cntys | $247.93 | $114.61 |
| Beaumont | $216.54 | $103.47 |
| Brazoria | $229.31 | $106.18 |
| Chicago | $245.80 | $120.93 |
| Chico | $245.33 | $109.15 |
| Colorado | $241.92 | $109.72 |
| Connecticut | $248.57 | $114.75 |
| Dallas | $230.94 | $107.19 |
| Dc + Md/Va Suburbs | $266.62 | $120.25 |
| Delaware | $229.76 | $107.00 |
| Detroit | $232.95 | $113.04 |
| East St. Louis | $228.38 | $114.07 |
| El Centro | $245.38 | $109.20 |
| Fort Lauderdale | $242.23 | $116.37 |
| Fort Worth | $229.37 | $106.86 |
| Fresno | $245.33 | $109.15 |
| Galveston | $230.10 | $106.72 |
| Hanford-Corcoran | $245.33 | $109.15 |
| Hawaii, Guam | $251.78 | $110.50 |
| Houston | $235.23 | $111.84 |
| Idaho | $213.97 | $99.66 |
| Indiana | $215.28 | $100.10 |
| Iowa | $212.41 | $98.72 |
| Kansas | $211.54 | $99.22 |
| Kentucky | $212.84 | $102.38 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $262.57 | $115.58 |
| Madera | $245.33 | $109.15 |
| Manhattan | $268.86 | $124.48 |
| Merced | $245.33 | $109.15 |
| Metropolitan Boston | $266.55 | $118.19 |
| Metropolitan Kansas City | $221.90 | $105.23 |
| Metropolitan Philadelphia | $242.19 | $112.85 |
| Metropolitan St. Louis | $224.34 | $106.06 |
| Miami | $253.73 | $124.38 |
| Minnesota | $230.81 | $102.95 |
| Mississippi | $206.44 | $99.46 |
| Modesto | $245.33 | $109.15 |
| Montana** | $232.45 | $108.20 |
| Napa | $285.19 | $121.43 |
| Nebraska | $213.59 | $98.90 |
| Nevada** | $231.08 | $106.70 |
| New Hampshire | $238.26 | $108.91 |
| New Mexico | $220.27 | $106.33 |
| New Orleans | $223.73 | $106.81 |
| North Carolina | $217.73 | $101.80 |
| North Dakota** | $226.92 | $102.66 |
| Northern Nj | $263.62 | $119.49 |
| Nyc Suburbs/Long Island | $275.97 | $128.24 |
| Ohio | $217.78 | $104.34 |
| Oklahoma | $212.23 | $101.27 |
| Oxnard-Thousand Oaks-Ventura | $261.32 | $114.46 |
| Portland | $249.77 | $111.72 |
| Poughkpsie/N Nyc Suburbs | $252.96 | $116.90 |
| Puerto Rico | $234.20 | $108.58 |
| Queens | $270.91 | $124.04 |
| Redding | $245.33 | $109.15 |
| Rest Of California | $245.33 | $109.15 |
| Rest Of Florida | $229.71 | $110.92 |
| Rest Of Georgia | $215.94 | $105.11 |
| Rest Of Illinois | $222.97 | $109.53 |
| Rest Of Louisiana | $212.56 | $102.60 |
| Rest Of Maine | $215.36 | $101.05 |
| Rest Of Maryland | $234.27 | $108.53 |
| Rest Of Massachusetts | $240.42 | $109.58 |
| Rest Of Michigan | $218.91 | $105.47 |
| Rest Of Missouri | $208.81 | $101.71 |
| Rest Of New Jersey | $251.13 | $115.44 |
| Rest Of New York | $221.21 | $103.17 |
| Rest Of Oregon | $229.01 | $105.26 |
| Rest Of Pennsylvania | $218.04 | $103.98 |
| Rest Of Texas | $222.91 | $105.00 |
| Rest Of Washington | $239.92 | $109.09 |
| Rhode Island | $238.07 | $109.72 |
| Riverside-San Bernardino-Ontario | $248.35 | $112.17 |
| Sacramento-Roseville-Folsom | $257.71 | $113.21 |
| Salinas | $256.77 | $112.76 |
| San Diego-Chula Vista-Carlsbad | $263.05 | $114.44 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $302.06 | $126.86 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $301.74 | $126.54 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $309.01 | $129.84 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $307.71 | $128.54 |
| San Luis Obispo-Paso Robles | $252.62 | $111.10 |
| Santa Cruz-Watsonville | $265.73 | $114.77 |
| Santa Maria-Santa Barbara | $257.79 | $112.92 |
| Santa Rosa-Petaluma | $268.42 | $115.84 |
| Seattle (King Cnty) | $271.95 | $119.49 |
| South Carolina | $218.17 | $103.36 |
| South Dakota** | $226.26 | $102.01 |
| Southern Maine | $227.49 | $104.36 |
| Stockton | $245.33 | $109.15 |
| Suburban Chicago | $244.65 | $117.04 |
| Tennessee | $212.70 | $99.76 |
| Utah | $221.34 | $104.54 |
| Vallejo | $284.73 | $120.97 |
| Vermont | $226.15 | $103.14 |
| Virgin Islands | $234.20 | $108.58 |
| Virginia | $226.84 | $104.70 |
| Visalia | $245.33 | $109.15 |
| West Virginia | $214.27 | $106.30 |
| Wisconsin | $218.87 | $99.84 |
| Wyoming** | $230.04 | $105.79 |
| Yuba City | $245.33 | $109.15 |
46320 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.
$204.01
$277.17
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 | $266.02 | 1 |
| AL | $207.20 | 1 |
| AR | $204.01 | 1 |
| AZ | $225.86 | 1 |
| CA | $245.33–$309.01 | 29 |
| CO | $241.92 | 1 |
| CT | $248.57 | 1 |
| DC | $266.62 | 1 |
| DE | $229.76 | 1 |
| FL | $229.71–$253.73 | 3 |
| GA | $215.94–$237.23 | 2 |
| GU | $251.78 | 1 |
| HI | $251.78 | 1 |
| IA | $212.41 | 1 |
| ID | $213.97 | 1 |
| IL | $222.97–$245.80 | 4 |
| IN | $215.28 | 1 |
| KS | $211.54 | 1 |
| KY | $212.84 | 1 |
| LA | $212.56–$223.73 | 2 |
| MA | $240.42–$266.55 | 2 |
| MD | $234.27–$266.62 | 3 |
| ME | $215.36–$227.49 | 2 |
| MI | $218.91–$232.95 | 2 |
| MN | $230.81 | 1 |
| MO | $208.81–$224.34 | 3 |
| MS | $206.44 | 1 |
| MT | $232.45 | 1 |
| NC | $217.73 | 1 |
| ND | $226.92 | 1 |
| NE | $213.59 | 1 |
| NH | $238.26 | 1 |
| NJ | $251.13–$263.62 | 2 |
| NM | $220.27 | 1 |
| NV | $231.08 | 1 |
| NY | $221.21–$275.97 | 5 |
| OH | $217.78 | 1 |
| OK | $212.23 | 1 |
| OR | $229.01–$249.77 | 2 |
| PA | $218.04–$242.19 | 2 |
| PR | $234.20 | 1 |
| RI | $238.07 | 1 |
| SC | $218.17 | 1 |
| SD | $226.26 | 1 |
| TN | $212.70 | 1 |
| TX | $216.54–$241.35 | 8 |
| UT | $221.34 | 1 |
| VA | $226.84–$266.62 | 2 |
| VI | $234.20 | 1 |
| VT | $226.15 | 1 |
| WA | $239.92–$271.95 | 2 |
| WI | $218.87 | 1 |
| WV | $214.27 | 1 |
| WY | $230.04 | 1 |
How the 46320 rate is calculated
Each of 46320’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 · 46320
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.60Practice expense 5.08Malpractice 0.28
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46320
46320 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46320
Hemorrhoid 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 · 46320
Hemorrhoid 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
46320 without 51 · national office
$232.47
Hemorrhoid excision
46320-51 · Second procedure: 50%
$116.24
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%).
46320 compared with similar codes
Compare codes
46320 vs 46083 vs 46250 vs 46255: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46083Hemorrhoid drainage
- Use 46083 for incision of the thrombosed external hemorrhoid; use 46320 when the lesion is excised.
- 46250Hemorrhoidectomy
- 46250 describes an external hemorrhoidectomy involving multiple columns or groups, rather than excision of a thrombosed external hemorrhoid.
- 46255Hemorrhoidectomy
- 46255 describes hemorrhoidectomy involving internal and external hemorrhoidal disease; 46320 is for excision of a thrombosed external hemorrhoid.
46320 billing questions
How is 46320 different from 46083?
46320 is for excision of the thrombosed external hemorrhoid. 46083 describes incision of a thrombosed external hemorrhoid, so the documented technique determines which code fits.
Can related postoperative visits be billed separately?
Related postoperative visits during the 10-day global period are included in 46320.
Should modifier 50 be appended for hemorrhoids on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 46320. 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
Fee sheets
Put 46320 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →