Billing code 46606: Anoscopy biopsyMedicare rate & RVUs
Report this service when standard anoscopy is used to inspect the anal canal and obtain one or more tissue biopsies for pathologic examination.
Medicare pays $306.95 for 46606 nationally in the office and $71.14 in a hospital or facility. Local office rates run $266.89–$423.60.
Medicare rate · 46606
Anoscopy biopsy
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- Work RVUs
- 1.17
- Total RVUs
- 9.19
- Global days
- 000
National rate · 2026
$306.95
Office setting, before claim adjustments.
See every locality for 46606 → · 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 46606 covers
A clinician examines the anal canal through an anoscope and takes one or more tissue samples from an abnormal area for pathologic evaluation. Colorectal surgeons and gastroenterologists commonly perform this service in an office or procedure room when inspection identifies tissue that needs histologic assessment, such as a suspicious mucosal lesion or ulcer. The biopsy distinguishes this service from diagnostic anoscopy without tissue sampling and from procedures that remove or ablate a lesion.
Report the code when the documented service includes tissue biopsy; record the finding and sampling site. Same-day preoperative and postoperative care is included in its 0-day global period. When related endoscopies are performed together, endoscopy family pricing applies, so the procedures are priced under the family rules rather than each being treated as an unrelated service. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, 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 46606 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
$266.89 to $423.60
109 of 109 payment localities
46606 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.
$266.89
$376.60
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 | $340.47 | 1 |
| AL | $271.41 | 1 |
| AR | $266.89 | 1 |
| AZ | $297.90 | 1 |
| CA | $329.59–$423.60 | 29 |
| CO | $322.68 | 1 |
| CT | $329.25 | 1 |
| DC | $356.31 | 1 |
| DE | $303.34 | 1 |
| FL | $298.82–$327.88 | 3 |
| GA | $280.03–$312.59 | 2 |
| GU | $339.93 | 1 |
| HI | $339.93 | 1 |
| IA | $280.72 | 1 |
| ID | $282.54 | 1 |
| IL | $287.99–$319.44 | 4 |
| IN | $284.45 | 1 |
| KS | $278.57 | 1 |
| KY | $277.39 | 1 |
| LA | $276.64–$292.45 | 2 |
| MA | $320.07–$358.49 | 2 |
| MD | $309.93–$356.31 | 3 |
| ME | $283.53–$302.14 | 2 |
| MI | $285.09–$302.40 | 2 |
| MN | $309.83 | 1 |
| MO | $270.74–$294.43 | 3 |
| MS | $268.90 | 1 |
| MT | $306.94 | 1 |
| NC | $287.04 | 1 |
| ND | $302.99 | 1 |
| NE | $282.69 | 1 |
| NH | $316.83 | 1 |
| NJ | $333.20–$351.66 | 2 |
| NM | $286.62 | 1 |
| NV | $306.10 | 1 |
| NY | $291.91–$364.55 | 5 |
| OH | $284.28 | 1 |
| OK | $277.52 | 1 |
| OR | $303.93–$334.86 | 2 |
| PA | $285.17–$319.66 | 2 |
| PR | $309.73 | 1 |
| RI | $315.59 | 1 |
| SC | $286.10 | 1 |
| SD | $302.52 | 1 |
| TN | $280.09 | 1 |
| TX | $282.97–$321.42 | 8 |
| UT | $290.60 | 1 |
| VA | $300.55–$356.31 | 2 |
| VI | $309.73 | 1 |
| VT | $301.04 | 1 |
| WA | $319.71–$366.98 | 2 |
| WI | $291.36 | 1 |
| WV | $275.62 | 1 |
| WY | $305.22 | 1 |
How the 46606 rate is calculated
Each of 46606’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 · 46606
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.17Practice expense 7.82Malpractice 0.20
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46606
The CMS indicators that decide how 46606 is paid alongside other services.
CMS payment indicators · 46606
Anoscopy biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46606 without 51 · national office
$306.95
Anoscopy biopsy
46606-51 · Second procedure: 50%
$153.48
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%).
46606 compared with similar codes
Compare codes
46606 vs 46600 vs 46607 vs 46610: national Medicare rates
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How to choose
- 46600Diagnostic anoscopy
- Use 46600 for diagnostic anoscopy without tissue biopsy. When tissue is sampled during standard anoscopy, use 46606.
- 46607Anoscopy
- 46607 includes biopsy during high-resolution anoscopy. Choose 46606 when the biopsy is performed with standard anoscopy.
- 46610Anoscopy
- 46610 describes removal of a lesion during anoscopy. Use 46606 when tissue is sampled for pathology without reporting lesion removal.
46606 billing questions
When should this be reported instead of 46600?
Report 46606 when anoscopy includes tissue biopsy. Use 46600 for diagnostic inspection without tissue biopsy.
How does 46606 differ from 46607?
Both include biopsy, but 46607 is for diagnostic anoscopy using high-resolution magnification. Report 46606 for biopsy with standard anoscopy.
Can the biopsy be reported separately from the anoscopy?
The biopsy is part of this anoscopy service; do not report a separate code for the tissue sampling itself.
Should modifier 50 be appended for bilateral findings?
No. Bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What happens when related endoscopies are performed in the same session?
CMS applies endoscopy family pricing to related endoscopies performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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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