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Billing code 46945: Hemorrhoid ligationMedicare rate & RVUs

Reports surgical ligation of one internal hemorrhoid column or group without imaging guidance, rather than destruction, stapling, or treatment of multiple columns.

CMS RVU26DEffective Oct 1, 2026109 payment localities1K Medicare services in 2024

Medicare pays $350.38 for 46945 nationally in a facility.

Medicare rate · 46945

Hemorrhoid ligation

Work RVUs
3.6
Total RVUs
10.49
Global days
090

National rate · 2026

$350.38

Facility setting, before claim adjustments.

See every locality for 46945 →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 46945 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 46945 covers

This service treats one internal hemorrhoid column or group by ligation using a method other than rubber-band ligation. A surgeon, commonly a colorectal or general surgeon, performs the procedure in an operating room or another procedural setting, typically using visualization of the anal canal. The code distinguishes a single column or group from treatment of two or more columns and from procedures that destroy or reposition hemorrhoidal tissue.

Report 46945 when the operative documentation supports ligation of one internal hemorrhoid column or group without imaging guidance. Documentation should identify the treated hemorrhoid and describe the ligation technique; use the multiple-column code when two or more columns are treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this anatomy-specific service. 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 46945 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

46945 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$315.21
Alaska*Unavailable$414.81
ArizonaUnavailable$340.90
ArkansasUnavailable$310.80
AtlantaUnavailable$358.25
AustinUnavailable$360.40
BakersfieldUnavailable$364.67
Baltimore/Surr. CntysUnavailable$372.50
BeaumontUnavailable$330.06
BrazoriaUnavailable$344.90

46945 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
46945 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 46945 rate is calculated

Each of 46945’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 · 46945

RVUs × geographic indexes × conversion factor

Work3.60

3.60 RVUs× 1.000 GPCI

Practice expense6.27

6.27 RVUs× 1.000 GPCI

Malpractice0.62

0.62 RVUs× 1.000 GPCI

Adjusted RVUs

10.4900

Conversion factor

$33.4009

Medicare rate

$350.38

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

Payment rules and modifiers for 46945

46945 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 46945

Hemorrhoid ligation

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 · 46945

Hemorrhoid ligation

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

46945 without 51 · national facility

$350.38

Hemorrhoid ligation

46945-51 · Second procedure: 50%

$175.19

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

46945 compared with similar codes

Compare codes · National

4 codes, side by side

  • 46945

    Hemorrhoid ligation3.6 wRVU

    Not priced

  • 46946

    Hemorrhoid ligation4.39 wRVU

    Not priced

  • 46930

    Hemorrhoid treatment1.57 wRVU

    $247.83

  • 46947

    Hemorrhoidopexy5.43 wRVU

    Not priced

How to choose

46946Hemorrhoid ligation
Both describe internal hemorrhoid ligation without imaging guidance; 46945 is for one column or group, while 46946 is for two or more.
46930Hemorrhoid treatment
Choose 46945 for ligation. Choose 46930 when internal hemorrhoids are destroyed rather than ligated.
46947Hemorrhoidopexy
46945 is ligation of one internal hemorrhoid column or group. 46947 describes stapled hemorrhoidopexy, a distinct surgical method.

Codes related to 46945

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

Codes related to 46945
CodeHow it relatesNational office range
Same family
46946Hemorrhoid ligationLigation for two or more internal hemorrhoid columns or groups, rather than one.No office rate
Used instead
46930Hemorrhoid treatmentDestroys internal hemorrhoids instead of treating a column or group by ligation.$217.76–$333.31
46947HemorrhoidopexyStapled hemorrhoidopexy is a different operative approach for internal hemorrhoids.No office rate
46948Hemorrhoid surgeryTransanal dearterialization is a different approach used for multiple internal hemorrhoids.No office rate

46945 billing questions

When should 46945 be used instead of 46946?

Use 46945 for ligation of one internal hemorrhoid column or group. When two or more columns are treated, use 46946.

How does this differ from 46930?

46945 describes ligation of an internal hemorrhoid column or group. 46930 is for destruction of internal hemorrhoids, a different treatment method.

What documentation supports reporting 46945?

The operative note should identify the internal hemorrhoid treated, support that one column or group was ligated, and describe the method used without imaging guidance.

Can modifier 50 be reported?

No. The anatomy and service descriptor make bilateral adjustment inappropriate for 46945.

How are related postoperative visits handled?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. 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
RVUs for 46945PPRRVU2026_Oct_nonQPP.csv, line 5,639 (RVU26D)

Open CMS sourceHow we calculate rates

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