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CMS RVU26D · Effective 2026-10-01

46604 in Merced

Office / nonfacility

$751.40

Base rate per service

Facility setting

$62.45

Base rate per service

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.

Anorectal procedure

About 46604: Anoscopy with anal canal dilation

Report this service when the clinician examines the anal canal with an anoscope and dilates a narrowed area during the procedure.

A clinician advances an anoscope to inspect the anal canal and dilates a narrowed segment under direct visualization. Dilation may use a balloon, guidewire, or bougie. A typical indication is anal canal narrowing that makes passage difficult or limits examination. Colorectal surgeons and other clinicians who perform anorectal procedures may provide the service in an office or outpatient facility.

Report this code when the documented service includes both anoscopic examination and dilation; a diagnostic examination without dilation is a different service. The note should identify the narrowing and document the dilation performed and its method. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Do not use modifier 50. Medicare does not pay an assistant-at-surgery claim for this service, and co-surgeon and team-surgery billing are not permitted.

CMS billing rules for 46604

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
Multiple procedures
Endoscopy family pricing applies when related endoscopies are performed together.
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 RVU1.00 · 5%
  • Practice expense (office) RVU19.51 · 94%
  • Malpractice RVU0.18 · 1%

1.1K

Medicare services in 2024 · #2911 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.

46604 compared with similar codes

Office rates for Merced, from the same CMS release.

46600

Diagnostic anoscopy

Standard visualization, optional washing

$138.38

Use 46600 for diagnostic anoscopy without dilation. Report 46604 when the clinician dilates a narrowed anal canal during the examination.

46606

Anoscopy biopsy

Biopsy performed

$329.59

46606 describes anoscopy with biopsy. Choose it when tissue sampling is performed rather than dilation; document the actual intervention.

45910

Rectal dilation

Under anesthesia

No office rate

45910 describes anal sphincter dilation under anesthesia other than local. It is distinct from dilation performed with anoscopy under 46604.

The same code, a different location

How does Merced compare?

In Bakersfield, the office rate for 46604 is $751.91—$0.51 higher than the $751.40 rate in Merced. Both use the same code, release and participation basis.

46604 across payment areas

Same release and payment basis · bars start at $0

  1. Merced · This locality

    $751.40

  2. Bakersfield

    $751.91

    $0.51 higher than Merced

  3. Chico

    $751.40

    The same base rate than Merced

  4. El Centro

    $751.43

    $0.03 higher than Merced

  5. Fresno

    $751.40

    The same base rate than Merced

  6. Hanford-Corcoran

    $751.40

    The same base rate than Merced

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $809.67

    $58.27 higher than Merced

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 46604 ranges from $596.27 in Arkansas to $979.98 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Modesto

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Napa

    California · 46604

    Office

    $897.44

    Facility

    $68.93

    $146.04 higher than Merced for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 46604

    Office

    $808.33

    Facility

    $65.32

    $56.93 higher than Merced for the office setting.

  • Redding

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Rest Of California

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 46604

    Office

    $753.34

    Facility

    $64.39

    $1.94 higher than Merced for the office setting.

  • Sacramento-Roseville-Folsom

    California · 46604

    Office

    $795.70

    Facility

    $64.63

    $44.30 higher than Merced for the office setting.

  • Salinas

    California · 46604

    Office

    $792.92

    Facility

    $64.37

    $41.52 higher than Merced for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 46604

    Office

    $817.04

    Facility

    $65.23

    $65.64 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 46604

    Office

    $958.16

    Facility

    $71.83

    $206.76 higher than Merced for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 46604

    Office

    $957.96

    Facility

    $71.62

    $206.56 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 46604

    Office

    $979.98

    Facility

    $73.53

    $228.58 higher than Merced for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 46604

    Office

    $979.14

    Facility

    $72.70

    $227.74 higher than Merced for the office setting.

  • San Luis Obispo-Paso Robles

    California · 46604

    Office

    $779.42

    Facility

    $63.44

    $28.02 higher than Merced for the office setting.

  • Santa Cruz-Watsonville

    California · 46604

    Office

    $829.08

    Facility

    $65.33

    $77.68 higher than Merced for the office setting.

  • Santa Maria-Santa Barbara

    California · 46604

    Office

    $797.38

    Facility

    $64.43

    $45.98 higher than Merced for the office setting.

  • Santa Rosa-Petaluma

    California · 46604

    Office

    $837.85

    Facility

    $65.93

    $86.45 higher than Merced for the office setting.

  • Stockton

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Vallejo

    California · 46604

    Office

    $897.14

    Facility

    $68.64

    $145.74 higher than Merced for the office setting.

  • Visalia

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Yuba City

    California · 46604

    Office

    $751.40

    Facility

    $62.45

    The same base rate than Merced for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 46604

    Office

    $809.54

    Facility

    $69.05

    $58.14 higher than Merced for the office setting.

  • Miami

    Florida · 46604

    Office

    $726.97

    Facility

    $72.60

    $24.43 lower than Merced for the office setting.

  • Chicago

    Illinois · 46604

    Office

    $702.34

    Facility

    $70.59

    $49.06 lower than Merced for the office setting.

  • Manhattan

    New York · 46604

    Office

    $802.29

    Facility

    $71.85

    $50.89 higher than Merced for the office setting.

  • Alaska*

    Alaska · 46604

    Office

    $747.42

    Facility

    $77.96

    $3.98 lower than Merced for the office setting.

  • Alabama

    Alabama · 46604

    Office

    $607.00

    Facility

    $56.97

    $144.40 lower than Merced for the office setting.

  • Arkansas

    Arkansas · 46604

    Office

    $596.27

    Facility

    $56.29

    $155.13 lower than Merced for the office setting.

  • Arizona

    Arizona · 46604

    Office

    $670.00

    Facility

    $60.88

    $81.40 lower than Merced for the office setting.

  • Colorado

    Colorado · 46604

    Office

    $731.85

    Facility

    $63.02

    $19.55 lower than Merced for the office setting.

  • Connecticut

    Connecticut · 46604

    Office

    $743.17

    Facility

    $66.16

    $8.23 lower than Merced for the office setting.

  • Delaware

    Delaware · 46604

    Office

    $682.80

    Facility

    $61.74

    $68.60 lower than Merced for the office setting.

  • Fort Lauderdale

    Florida · 46604

    Office

    $704.39

    Facility

    $67.62

    $47.01 lower than Merced for the office setting.

  • Rest Of Florida

    Florida · 46604

    Office

    $665.42

    Facility

    $64.47

    $85.98 lower than Merced for the office setting.

  • Atlanta

    Georgia · 46604

    Office

    $702.80

    Facility

    $64.14

    $48.60 lower than Merced for the office setting.

  • Rest Of Georgia

    Georgia · 46604

    Office

    $621.84

    Facility

    $61.12

    $129.56 lower than Merced for the office setting.

  • Hawaii, Guam

    Hawaii · 46604

    Office

    $777.81

    Facility

    $63.09

    $26.41 higher than Merced for the office setting.

  • Iowa

    Iowa · 46604

    Office

    $632.05

    Facility

    $56.88

    $119.35 lower than Merced for the office setting.

  • Idaho

    Idaho · 46604

    Office

    $635.76

    Facility

    $57.45

    $115.64 lower than Merced for the office setting.

  • East St. Louis

    Illinois · 46604

    Office

    $645.03

    Facility

    $66.71

    $106.37 lower than Merced for the office setting.

  • Rest Of Illinois

    Illinois · 46604

    Office

    $637.76

    Facility

    $63.84

    $113.64 lower than Merced for the office setting.

  • Suburban Chicago

    Illinois · 46604

    Office

    $713.53

    Facility

    $67.96

    $37.87 lower than Merced for the office setting.

  • Indiana

    Indiana · 46604

    Office

    $640.40

    Facility

    $57.69

    $111.00 lower than Merced for the office setting.

  • Kansas

    Kansas · 46604

    Office

    $625.52

    Facility

    $57.27

    $125.88 lower than Merced for the office setting.

  • Kentucky

    Kentucky · 46604

    Office

    $618.22

    Facility

    $59.39

    $133.18 lower than Merced for the office setting.

  • New Orleans

    Louisiana · 46604

    Office

    $653.43

    Facility

    $61.92

    $97.97 lower than Merced for the office setting.

  • Rest Of Louisiana

    Louisiana · 46604

    Office

    $615.87

    Facility

    $59.56

    $135.53 lower than Merced for the office setting.

  • Metropolitan Boston

    Massachusetts · 46604

    Office

    $818.19

    Facility

    $67.64

    $66.79 higher than Merced for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 46604

    Office

    $724.92

    Facility

    $63.00

    $26.48 lower than Merced for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 46604

    Office

    $740.59

    Facility

    $66.10

    $10.81 lower than Merced for the office setting.

  • Rest Of Maryland

    Maryland · 46604

    Office

    $698.73

    Facility

    $62.58

    $52.67 lower than Merced for the office setting.

  • Rest Of Maine

    Maine · 46604

    Office

    $636.66

    Facility

    $58.34

    $114.74 lower than Merced for the office setting.

  • Southern Maine

    Maine · 46604

    Office

    $682.98

    Facility

    $60.03

    $68.42 lower than Merced for the office setting.

  • Detroit

    Michigan · 46604

    Office

    $672.38

    Facility

    $65.78

    $79.02 lower than Merced for the office setting.

  • Rest Of Michigan

    Michigan · 46604

    Office

    $635.15

    Facility

    $61.23

    $116.25 lower than Merced for the office setting.

  • Minnesota

    Minnesota · 46604

    Office

    $705.73

    Facility

    $58.90

    $45.67 lower than Merced for the office setting.

  • Metropolitan Kansas City

    Missouri · 46604

    Office

    $651.18

    Facility

    $60.92

    $100.22 lower than Merced for the office setting.

  • Metropolitan St. Louis

    Missouri · 46604

    Office

    $659.80

    Facility

    $61.37

    $91.60 lower than Merced for the office setting.

  • Rest Of Missouri

    Missouri · 46604

    Office

    $600.98

    Facility

    $59.12

    $150.42 lower than Merced for the office setting.

  • Mississippi

    Mississippi · 46604

    Office

    $598.92

    Facility

    $57.69

    $152.48 lower than Merced for the office setting.

  • Montana**

    Montana · 46604

    Office

    $691.05

    Facility

    $62.45

    $60.35 lower than Merced for the office setting.

  • North Carolina

    North Carolina · 46604

    Office

    $645.23

    Facility

    $58.75

    $106.17 lower than Merced for the office setting.

  • North Dakota**

    North Dakota · 46604

    Office

    $687.49

    Facility

    $58.89

    $63.91 lower than Merced for the office setting.

  • Nebraska

    Nebraska · 46604

    Office

    $637.15

    Facility

    $56.95

    $114.25 lower than Merced for the office setting.

  • New Hampshire

    New Hampshire · 46604

    Office

    $717.03

    Facility

    $62.65

    $34.37 lower than Merced for the office setting.

  • Northern Nj

    New Jersey · 46604

    Office

    $797.84

    Facility

    $68.66

    $46.44 higher than Merced for the office setting.

  • Rest Of New Jersey

    New Jersey · 46604

    Office

    $752.94

    Facility

    $66.50

    $1.54 higher than Merced for the office setting.

  • New Mexico

    New Mexico · 46604

    Office

    $638.19

    Facility

    $61.76

    $113.21 lower than Merced for the office setting.

  • Nevada**

    Nevada · 46604

    Office

    $690.71

    Facility

    $61.48

    $60.69 lower than Merced for the office setting.

  • Nyc Suburbs/Long Island

    New York · 46604

    Office

    $821.52

    Facility

    $74.11

    $70.12 higher than Merced for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 46604

    Office

    $755.74

    Facility

    $67.41

    $4.34 higher than Merced for the office setting.

  • Queens

    New York · 46604

    Office

    $814.46

    Facility

    $71.45

    $63.06 higher than Merced for the office setting.

  • Rest Of New York

    New York · 46604

    Office

    $656.70

    Facility

    $59.52

    $94.70 lower than Merced for the office setting.

  • Ohio

    Ohio · 46604

    Office

    $634.42

    Facility

    $60.50

    $116.98 lower than Merced for the office setting.

  • Oklahoma

    Oklahoma · 46604

    Office

    $620.00

    Facility

    $58.65

    $131.40 lower than Merced for the office setting.

  • Portland

    Oregon · 46604

    Office

    $762.39

    Facility

    $64.01

    $10.99 higher than Merced for the office setting.

  • Rest Of Oregon

    Oregon · 46604

    Office

    $686.67

    Facility

    $60.58

    $64.73 lower than Merced for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 46604

    Office

    $719.54

    Facility

    $65.17

    $31.86 lower than Merced for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 46604

    Office

    $637.30

    Facility

    $60.24

    $114.10 lower than Merced for the office setting.

  • Puerto Rico

    Puerto Rico · 46604

    Office

    $698.14

    Facility

    $62.62

    $53.26 lower than Merced for the office setting.

  • Rhode Island

    Rhode Island · 46604

    Office

    $712.55

    Facility

    $63.21

    $38.85 lower than Merced for the office setting.

  • South Carolina

    South Carolina · 46604

    Office

    $640.64

    Facility

    $59.81

    $110.76 lower than Merced for the office setting.

  • South Dakota**

    South Dakota · 46604

    Office

    $687.07

    Facility

    $58.47

    $64.33 lower than Merced for the office setting.

  • Tennessee

    Tennessee · 46604

    Office

    $628.98

    Facility

    $57.58

    $122.42 lower than Merced for the office setting.

  • Austin

    Texas · 46604

    Office

    $728.24

    Facility

    $63.18

    $23.16 lower than Merced for the office setting.

  • Beaumont

    Texas · 46604

    Office

    $631.99

    Facility

    $59.96

    $119.41 lower than Merced for the office setting.

  • Brazoria

    Texas · 46604

    Office

    $684.14

    Facility

    $61.20

    $67.26 lower than Merced for the office setting.

  • Dallas

    Texas · 46604

    Office

    $687.90

    Facility

    $61.81

    $63.50 lower than Merced for the office setting.

  • Fort Worth

    Texas · 46604

    Office

    $681.47

    Facility

    $61.66

    $69.93 lower than Merced for the office setting.

  • Galveston

    Texas · 46604

    Office

    $685.74

    Facility

    $61.53

    $65.66 lower than Merced for the office setting.

  • Houston

    Texas · 46604

    Office

    $689.03

    Facility

    $64.83

    $62.37 lower than Merced for the office setting.

  • Rest Of Texas

    Texas · 46604

    Office

    $657.25

    Facility

    $60.70

    $94.15 lower than Merced for the office setting.

  • Utah

    Utah · 46604

    Office

    $651.35

    Facility

    $60.46

    $100.05 lower than Merced for the office setting.

  • Virginia

    Virginia · 46604

    Office

    $678.22

    Facility

    $60.30

    $73.18 lower than Merced for the office setting.

  • Virgin Islands

    United States Virgin Islands · 46604

    Office

    $698.14

    Facility

    $62.62

    $53.26 lower than Merced for the office setting.

  • Vermont

    Vermont · 46604

    Office

    $681.58

    Facility

    $59.26

    $69.82 lower than Merced for the office setting.

  • Rest Of Washington

    Washington · 46604

    Office

    $724.60

    Facility

    $62.68

    $26.80 lower than Merced for the office setting.

  • Seattle (King Cnty)

    Washington · 46604

    Office

    $839.56

    Facility

    $68.26

    $88.16 higher than Merced for the office setting.

  • Wisconsin

    Wisconsin · 46604

    Office

    $659.53

    Facility

    $57.33

    $91.87 lower than Merced for the office setting.

  • West Virginia

    West Virginia · 46604

    Office

    $608.29

    Facility

    $62.03

    $143.11 lower than Merced for the office setting.

  • Wyoming**

    Wyoming · 46604

    Office

    $689.50

    Facility

    $60.90

    $61.90 lower than Merced for the office setting.

See how rates vary across the country

46604 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$596.27

$865.69

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$747.421
AL$607.001
AR$596.271
AZ$670.001
CA$751.40–$979.9829
CO$731.851
CT$743.171
DC$809.541
DE$682.801
FL$665.42–$726.973
GA$621.84–$702.802
GU$777.811
HI$777.811
IA$632.051
ID$635.761
IL$637.76–$713.534
IN$640.401
KS$625.521
KY$618.221
LA$615.87–$653.432
MA$724.92–$818.192
MD$698.73–$809.543
ME$636.66–$682.982
MI$635.15–$672.382
MN$705.731
MO$600.98–$659.803
MS$598.921
MT$691.051
NC$645.231
ND$687.491
NE$637.151
NH$717.031
NJ$752.94–$797.842
NM$638.191
NV$690.711
NY$656.70–$821.525
OH$634.421
OK$620.001
OR$686.67–$762.392
PA$637.30–$719.542
PR$698.141
RI$712.551
SC$640.641
SD$687.071
TN$628.981
TX$631.99–$728.248
UT$651.351
VA$678.22–$809.542
VI$698.141
VT$681.581
WA$724.60–$839.562
WI$659.531
WV$608.291
WY$689.501

Explore 46604 on the national rate map →

Where does this rate apply?

Merced is a Medicare payment area. Our Census mapping connects it to 24 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 46604 in Merced, the physician’s office rate is $751.40 and the facility-setting rate is $62.45: a difference of $688.95.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 46604 in Merced. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$826.54

$751.40 × 110% = $826.54

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 46604 in Merced.

PPRRVU2026_Oct_nonQPP.csv

5,600

Code
46604
Physician work
1.00
Practice expense
19.51
Malpractice
0.18

GPCI2026.csv

15

Locality
Merced
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 46604 in Merced
ComponentRVULocality factorAdjusted
Physician work1.00× 1.0171.0170
Practice expense19.51× 1.09621.3830
Malpractice0.18× 0.5360.0965
Total RVUs22.4964
Conversion factor× 33.4009

Office / nonfacility rate, Merced$751.40

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

Open 46604 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work11.017
Practice expense19.511.096
Malpractice0.180.536

(1 × 1.017 + 19.51 × 1.096 + 0.18 × 0.536) × $33.4009 = $751.40

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work11.017
Practice expense0.691.096
Malpractice0.180.536

(1 × 1.017 + 0.69 × 1.096 + 0.18 × 0.536) × $33.4009 = $62.45

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

46604 · Office / nonfacility

$751.40

Effective 2026-10-01

The base rate is $109.45 higher than on 2025-10-01, moving from $641.95 to $751.40 (17.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $641.95changed to$751.40

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.03 changed to 1.00
    • Practice expense RVU 17.12 changed to 19.51
    • Malpractice RVU 0.16 changed to 0.18
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $641.95

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$751.40$62.45RVU26D
2026-07-01$751.40$62.45RVU26C
2026-04-01$751.40$62.45RVU26B
2026-01-01$751.40$62.45RVU26A
2025-10-01$641.95$64.61RVU25D
2025-07-01$641.95$64.61RVU25C
2025-04-01$641.95$64.61RVU25B
2025-01-01$641.95$64.61RVU25A

46604 billing questions

When should I report this instead of diagnostic anoscopy?

Report this code when the clinician performs dilation of a narrowed anal canal during anoscopy. A diagnostic examination without dilation points to 46600.

Can I report a biopsy separately when dilation is performed?

This code represents anoscopy with dilation, not biopsy. If the clinician also takes a biopsy, document the additional work and apply the applicable coding and endoscopy family pricing rules.

Should I append modifier 50?

No. Medicare's bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

Is same-day evaluation and management work included?

The code has a 0-day global period, which includes same-day preoperative and postoperative care.

Can an assistant or co-surgeon be billed?

Medicare does not pay an assistant-at-surgery claim for this service. Co-surgeon and team-surgery billing are not permitted.

What documentation supports reporting dilation?

Document the anal canal narrowing and the dilation actually performed, including the method used. An anoscopic examination alone does not support this code.

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.

RVUs for 46604PPRRVU2026_Oct_nonQPP.csv, line 5,600 (RVU26D)
Geographic factors for MercedGPCI2026.csv, line 15 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet