No office rate
Use 46945 when one internal hemorrhoid is treated by ligation without imaging guidance; use 46946 when two or more are treated.
On this page
CMS RVU26D · Effective 2026-10-01
46946 Hemorrhoid ligation Medicare reimbursement rates
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization. Compare 46946 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 46946?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$342.64–$484.45
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $141.81 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 46946 pays more and less
Colorectal surgery
About 46946: Internal hemorrhoid ligation, multiple
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization.
A surgeon treats at least two internal hemorrhoids by ligating them without imaging guidance. This is a surgical approach, distinct from office rubber-band ligation and from Doppler-guided transanal hemorrhoidal dearterialization. Colorectal and general surgeons commonly perform it in an operating room or ambulatory surgery setting for symptomatic internal hemorrhoids when operative ligation is selected.
Choose this code when two or more hemorrhoids are treated during the procedure; use the single-hemorrhoid code when only one is treated. The operative report should support the number treated and the ligation method, including that imaging guidance was not used. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46946
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.39 · 38%
- Practice expense (office) RVU6.43 · 56%
- Malpractice RVU0.67 · 6%
2.1K
Medicare services in 2024 · #2416 by national volume
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.
46946 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
46948 describes transanal hemorrhoidal dearterialization with imaging guidance. This code is for ligation of multiple hemorrhoids without imaging guidance.
$217.76–$333.31
46930 describes destruction of internal hemorrhoids, not the surgical ligation represented by 46946.
No office rate
46947 is for stapled hemorrhoidopexy, a distinct operative method rather than ligation of multiple internal hemorrhoids.
See how rates vary across the country
46946 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 46946 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $347.22 |
| Alaska* | Office Unavailable | Facility $461.00 |
| Arizona | Office Unavailable | Facility $373.90 |
| Arkansas | Office Unavailable | Facility $342.64 |
| Atlanta | Office Unavailable | Facility $392.15 |
| Austin | Office Unavailable | Facility $393.97 |
| Bakersfield | Office Unavailable | Facility $398.43 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $407.10 |
| Beaumont | Office Unavailable | Facility $362.86 |
| Brazoria | Office Unavailable | Facility $378.09 |
| Chicago | Office Unavailable | Facility $414.86 |
| Chico | Office Unavailable | Facility $396.50 |
| Colorado | Office Unavailable | Facility $394.38 |
| Connecticut | Office Unavailable | Facility $407.95 |
| Dallas | Office Unavailable | Facility $381.06 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $432.45 |
| Delaware | Office Unavailable | Facility $379.67 |
| Detroit | Office Unavailable | Facility $391.61 |
| East St. Louis | Office Unavailable | Facility $389.29 |
| El Centro | Office Unavailable | Facility $396.61 |
| Fort Lauderdale | Office Unavailable | Facility $404.65 |
| Fort Worth | Office Unavailable | Facility $379.20 |
| Fresno | Office Unavailable | Facility $396.50 |
| Galveston | Office Unavailable | Facility $379.60 |
| Hanford-Corcoran | Office Unavailable | Facility $396.50 |
| Hawaii, Guam | Office Unavailable | Facility $403.78 |
| Houston | Office Unavailable | Facility $391.86 |
| Idaho | Office Unavailable | Facility $354.80 |
| Indiana | Office Unavailable | Facility $356.60 |
| Iowa | Office Unavailable | Facility $352.03 |
| Kansas | Office Unavailable | Facility $352.06 |
| Kentucky | Office Unavailable | Facility $358.03 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $421.57 |
| Madera | Office Unavailable | Facility $396.50 |
| Manhattan | Office Unavailable | Facility $441.07 |
| Merced | Office Unavailable | Facility $396.50 |
| Metropolitan Boston | Office Unavailable | Facility $428.99 |
| Metropolitan Kansas City | Office Unavailable | Facility $370.16 |
| Metropolitan Philadelphia | Office Unavailable | Facility $399.54 |
| Metropolitan St. Louis | Office Unavailable | Facility $373.51 |
| Miami | Office Unavailable | Facility $426.80 |
| Minnesota | Office Unavailable | Facility $374.25 |
| Mississippi | Office Unavailable | Facility $348.08 |
| Modesto | Office Unavailable | Facility $396.50 |
| Montana** | Office Unavailable | Facility $383.73 |
| Napa | Office Unavailable | Facility $450.30 |
| Nebraska | Office Unavailable | Facility $353.32 |
| Nevada** | Office Unavailable | Facility $380.25 |
| New Hampshire | Office Unavailable | Facility $389.78 |
| New Mexico | Office Unavailable | Facility $370.45 |
| New Orleans | Office Unavailable | Facility $374.15 |
| North Carolina | Office Unavailable | Facility $361.31 |
| North Dakota** | Office Unavailable | Facility $370.48 |
| Northern Nj | Office Unavailable | Facility $428.90 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $452.93 |
| Ohio | Office Unavailable | Facility $365.27 |
| Oklahoma | Office Unavailable | Facility $355.81 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $418.53 |
| Portland | Office Unavailable | Facility $404.23 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $415.48 |
| Puerto Rico | Office Unavailable | Facility $385.80 |
| Queens | Office Unavailable | Facility $442.14 |
| Redding | Office Unavailable | Facility $396.50 |
| Rest Of California | Office Unavailable | Facility $396.50 |
| Rest Of Florida | Office Unavailable | Facility $385.58 |
| Rest Of Georgia | Office Unavailable | Facility $364.88 |
| Rest Of Illinois | Office Unavailable | Facility $377.69 |
| Rest Of Louisiana | Office Unavailable | Facility $358.14 |
| Rest Of Maine | Office Unavailable | Facility $358.14 |
| Rest Of Maryland | Office Unavailable | Facility $385.98 |
| Rest Of Massachusetts | Office Unavailable | Facility $392.96 |
| Rest Of Michigan | Office Unavailable | Facility $367.98 |
| Rest Of Missouri | Office Unavailable | Facility $353.56 |
| Rest Of New Jersey | Office Unavailable | Facility $411.57 |
| Rest Of New York | Office Unavailable | Facility $366.39 |
| Rest Of Oregon | Office Unavailable | Facility $376.27 |
| Rest Of Pennsylvania | Office Unavailable | Facility $364.93 |
| Rest Of Texas | Office Unavailable | Facility $370.65 |
| Rest Of Washington | Office Unavailable | Facility $391.72 |
| Rhode Island | Office Unavailable | Facility $391.23 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $403.74 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $413.68 |
| Salinas | Office Unavailable | Facility $412.09 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $420.02 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $473.65 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $472.89 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $484.45 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $481.34 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $405.74 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $422.65 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $413.15 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $426.76 |
| Seattle (King Cnty) | Office Unavailable | Facility $435.76 |
| South Carolina | Office Unavailable | Facility $364.10 |
| South Dakota** | Office Unavailable | Facility $368.92 |
| Southern Maine | Office Unavailable | Facility $373.59 |
| Stockton | Office Unavailable | Facility $396.50 |
| Suburban Chicago | Office Unavailable | Facility $407.88 |
| Tennessee | Office Unavailable | Facility $353.87 |
| Utah | Office Unavailable | Facility $368.61 |
| Vallejo | Office Unavailable | Facility $449.20 |
| Vermont | Office Unavailable | Facility $370.57 |
| Virgin Islands | Office Unavailable | Facility $385.80 |
| Virginia | Office Unavailable | Facility $373.55 |
| Visalia | Office Unavailable | Facility $396.50 |
| West Virginia | Office Unavailable | Facility $365.29 |
| Wisconsin | Office Unavailable | Facility $359.27 |
| Wyoming** | Office Unavailable | Facility $377.96 |
| Yuba City | Office Unavailable | Facility $396.50 |
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46946 billing questions
When should I report this instead of 46945?
Report 46946 when at least two internal hemorrhoids are ligated in the procedure. Code 46945 is for treatment of a single hemorrhoid.
How does this differ from rubber-band ligation?
This code represents surgical ligation other than rubber-band ligation. Do not select it solely because multiple hemorrhoids were treated with office banding.
Is modifier 50 appropriate when hemorrhoids are on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What if another procedure is performed in the same session?
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,63746940,,Treatment of anal fissure,A,,2.29,6.05,,1.45,,0.35,8.69,4.09,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63846942,,Treatment of anal fissure,A,,2.02,6.01,,1.39,,0.29,8.32,3.70,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63946945,,Int hrhc lig 1 hroid w/o img,A,,3.60,6.27,NA,6.27,,0.62,10.49,10.49,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64046946,,Int hrhc lig 2+hroid w/o img,A,,4.39,6.43,NA,6.43,,0.67,11.49,11.49,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64146947,,Hemorrhoidopexy by stapling,A,,5.43,4.71,NA,4.71,,1.22,11.36,11.36,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64246948,,Int hrhc tranal dartlzj 2+,A,,5.43,6.82,NA,6.82,,1.09,13.34,13.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64346999,,Unlisted procedure anus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00