FeeBase
Log inGet started
Menu
On this page

CMS RVU26D · Effective 2026-10-01

46221 in Redding

Office / nonfacility

$344.12

Base rate per service

Facility setting

$203.18

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 procedures

About 46221: Internal hemorrhoid rubber-band ligation

Reports office or facility treatment of internal hemorrhoids by placing rubber bands around hemorrhoidal tissue to reduce its blood supply.

This procedure treats internal hemorrhoids by placing a tight rubber band around the base of hemorrhoidal tissue, typically with an anoscope for visualization. Colorectal surgeons, general surgeons, and gastroenterologists commonly perform it in an outpatient office or facility for symptomatic internal hemorrhoids, such as those causing bleeding or prolapse. The service is for ligation by rubber band, not removal of external hemorrhoids or excision of hemorrhoidal tissue.

Report 46221 for the band-ligation service, including when more than one internal hemorrhoid is treated in the session; document the indication, internal site, technique, and treated tissue. Related postoperative visits for 10 days are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.

CMS billing rules for 46221

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU2.30 · 24%
  • Practice expense (office) RVU7.09 · 73%
  • Malpractice RVU0.36 · 4%

68.8K

Medicare services in 2024 · #679 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.

46221 compared with similar codes

Office rates for Redding, from the same CMS release.

46930

Hemorrhoid treatment

Thermal energy

$263.37

Use 46221 when internal hemorrhoidal tissue is treated with rubber bands; 46930 describes thermal destruction.

46945

Hemorrhoid ligation

One column, no imaging

No office rate

Both treat internal hemorrhoids by ligation, but 46945 is for ligation by a method other than rubber-band ligation.

46255

Hemorrhoidectomy

One internal and external group

$606.81

46221 is band ligation of internal tissue. 46255 describes excision of an internal and external hemorrhoid group.

46250

Hemorrhoidectomy

External, two or more groups

$561.64

46250 is excision of multiple external hemorrhoid groups; 46221 treats internal hemorrhoids by rubber-band ligation.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 46221 is $345.15—$1.03 higher than the $344.12 rate in Redding. Both use the same code, release and participation basis.

46221 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $344.12

  2. Bakersfield

    $345.15

    $1.03 higher than Redding

  3. Chico

    $344.12

    The same base rate than Redding

  4. El Centro

    $344.18

    $0.06 higher than Redding

  5. Fresno

    $344.12

    The same base rate than Redding

  6. Hanford-Corcoran

    $344.12

    The same base rate than Redding

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

    $368.10

    $23.98 higher than Redding

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, 46221 ranges from $286.44 in Arkansas to $433.20 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 · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Merced

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Modesto

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Napa

    California · 46221

    Office

    $399.89

    Facility

    $230.40

    $55.77 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 46221

    Office

    $366.38

    Facility

    $214.38

    $22.26 higher than Redding for the office setting.

  • Rest Of California

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 46221

    Office

    $348.01

    Facility

    $207.07

    $3.89 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 46221

    Office

    $361.45

    Facility

    $211.89

    $17.33 higher than Redding for the office setting.

  • Salinas

    California · 46221

    Office

    $360.11

    Facility

    $211.07

    $15.99 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 46221

    Office

    $368.87

    Facility

    $215.07

    $24.75 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 46221

    Office

    $423.54

    Facility

    $242.23

    $79.42 higher than Redding for the office setting.

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

    California · 46221

    Office

    $423.14

    Facility

    $241.82

    $79.02 higher than Redding for the office setting.

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

    California · 46221

    Office

    $433.20

    Facility

    $247.77

    $89.08 higher than Redding for the office setting.

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

    California · 46221

    Office

    $431.53

    Facility

    $246.10

    $87.41 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 46221

    Office

    $354.30

    Facility

    $207.83

    $10.18 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 46221

    Office

    $372.61

    Facility

    $216.37

    $28.49 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 46221

    Office

    $361.54

    Facility

    $211.60

    $17.42 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 46221

    Office

    $376.38

    Facility

    $218.46

    $32.26 higher than Redding for the office setting.

  • Stockton

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 46221

    Office

    $399.30

    Facility

    $229.81

    $55.18 higher than Redding for the office setting.

  • Visalia

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 46221

    Office

    $344.12

    Facility

    $203.18

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 46221

    Office

    $373.32

    Facility

    $221.84

    $29.20 higher than Redding for the office setting.

  • Miami

    Florida · 46221

    Office

    $353.75

    Facility

    $219.89

    $9.63 higher than Redding for the office setting.

  • Chicago

    Illinois · 46221

    Office

    $342.95

    Facility

    $213.72

    $1.17 lower than Redding for the office setting.

  • Manhattan

    New York · 46221

    Office

    $375.99

    Facility

    $226.56

    $31.87 higher than Redding for the office setting.

  • Alaska*

    Alaska · 46221

    Office

    $374.06

    Facility

    $237.11

    $29.94 higher than Redding for the office setting.

  • Alabama

    Alabama · 46221

    Office

    $290.84

    Facility

    $178.32

    $53.28 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 46221

    Office

    $286.44

    Facility

    $175.97

    $57.68 lower than Redding for the office setting.

  • Arizona

    Arizona · 46221

    Office

    $316.59

    Facility

    $191.98

    $27.53 lower than Redding for the office setting.

  • Colorado

    Colorado · 46221

    Office

    $339.10

    Facility

    $202.28

    $5.02 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 46221

    Office

    $347.95

    Facility

    $209.46

    $3.83 higher than Redding for the office setting.

  • Delaware

    Delaware · 46221

    Office

    $321.99

    Facility

    $194.94

    $22.13 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 46221

    Office

    $338.45

    Facility

    $208.19

    $5.67 lower than Redding for the office setting.

  • Rest Of Florida

    Florida · 46221

    Office

    $321.29

    Facility

    $198.35

    $22.83 lower than Redding for the office setting.

  • Atlanta

    Georgia · 46221

    Office

    $332.10

    Facility

    $201.44

    $12.02 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 46221

    Office

    $302.39

    Facility

    $187.69

    $41.73 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 46221

    Office

    $353.04

    Facility

    $206.83

    $8.92 higher than Redding for the office setting.

  • Iowa

    Iowa · 46221

    Office

    $298.28

    Facility

    $180.62

    $45.84 lower than Redding for the office setting.

  • Idaho

    Idaho · 46221

    Office

    $300.38

    Facility

    $182.07

    $43.74 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 46221

    Office

    $318.91

    Facility

    $200.60

    $25.21 lower than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 46221

    Office

    $311.83

    Facility

    $194.42

    $32.29 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 46221

    Office

    $341.87

    Facility

    $209.81

    $2.25 lower than Redding for the office setting.

  • Indiana

    Indiana · 46221

    Office

    $302.19

    Facility

    $182.98

    $41.93 lower than Redding for the office setting.

  • Kansas

    Kansas · 46221

    Office

    $296.96

    Facility

    $180.71

    $47.16 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 46221

    Office

    $298.35

    Facility

    $184.03

    $45.77 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 46221

    Office

    $313.32

    Facility

    $192.32

    $30.80 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 46221

    Office

    $297.92

    Facility

    $184.12

    $46.20 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 46221

    Office

    $373.43

    Facility

    $219.89

    $29.31 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 46221

    Office

    $337.00

    Facility

    $201.59

    $7.12 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 46221

    Office

    $347.02

    Facility

    $209.04

    $2.90 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 46221

    Office

    $328.28

    Facility

    $198.15

    $15.84 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 46221

    Office

    $302.17

    Facility

    $183.86

    $41.95 lower than Redding for the office setting.

  • Southern Maine

    Maine · 46221

    Office

    $319.09

    Facility

    $191.65

    $25.03 lower than Redding for the office setting.

  • Detroit

    Michigan · 46221

    Office

    $325.62

    Facility

    $201.53

    $18.50 lower than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 46221

    Office

    $306.61

    Facility

    $189.20

    $37.51 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 46221

    Office

    $324.06

    Facility

    $191.74

    $20.06 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 46221

    Office

    $310.94

    Facility

    $190.19

    $33.18 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 46221

    Office

    $314.32

    Facility

    $191.89

    $29.80 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 46221

    Office

    $292.67

    Facility

    $181.82

    $51.45 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 46221

    Office

    $289.60

    Facility

    $178.88

    $54.52 lower than Redding for the office setting.

  • Montana**

    Montana · 46221

    Office

    $325.63

    Facility

    $197.04

    $18.49 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 46221

    Office

    $305.45

    Facility

    $185.47

    $38.67 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 46221

    Office

    $318.52

    Facility

    $189.92

    $25.60 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 46221

    Office

    $299.95

    Facility

    $181.25

    $44.17 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 46221

    Office

    $333.87

    Facility

    $200.00

    $10.25 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 46221

    Office

    $369.21

    Facility

    $220.04

    $25.09 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 46221

    Office

    $351.68

    Facility

    $211.26

    $7.56 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 46221

    Office

    $308.42

    Facility

    $190.50

    $35.70 lower than Redding for the office setting.

  • Nevada**

    Nevada · 46221

    Office

    $323.89

    Facility

    $195.17

    $20.23 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 46221

    Office

    $385.64

    Facility

    $232.74

    $41.52 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 46221

    Office

    $354.14

    Facility

    $213.33

    $10.02 higher than Redding for the office setting.

  • Queens

    New York · 46221

    Office

    $378.99

    Facility

    $226.99

    $34.87 higher than Redding for the office setting.

  • Rest Of New York

    New York · 46221

    Office

    $310.25

    Facility

    $188.08

    $33.87 lower than Redding for the office setting.

  • Ohio

    Ohio · 46221

    Office

    $305.15

    Facility

    $187.75

    $38.97 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 46221

    Office

    $297.64

    Facility

    $182.80

    $46.48 lower than Redding for the office setting.

  • Portland

    Oregon · 46221

    Office

    $350.10

    Facility

    $207.23

    $5.98 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 46221

    Office

    $321.14

    Facility

    $193.06

    $22.98 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 46221

    Office

    $339.07

    Facility

    $205.21

    $5.05 lower than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 46221

    Office

    $305.58

    Facility

    $187.53

    $38.54 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 46221

    Office

    $328.08

    Facility

    $198.08

    $16.04 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 46221

    Office

    $333.63

    Facility

    $200.80

    $10.49 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 46221

    Office

    $305.86

    Facility

    $187.04

    $38.26 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 46221

    Office

    $317.67

    Facility

    $189.08

    $26.45 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 46221

    Office

    $298.54

    Facility

    $181.65

    $45.58 lower than Redding for the office setting.

  • Austin

    Texas · 46221

    Office

    $338.18

    Facility

    $202.12

    $5.94 lower than Redding for the office setting.

  • Beaumont

    Texas · 46221

    Office

    $303.49

    Facility

    $186.47

    $40.63 lower than Redding for the office setting.

  • Brazoria

    Texas · 46221

    Office

    $321.50

    Facility

    $194.06

    $22.62 lower than Redding for the office setting.

  • Dallas

    Texas · 46221

    Office

    $323.70

    Facility

    $195.62

    $20.42 lower than Redding for the office setting.

  • Fort Worth

    Texas · 46221

    Office

    $321.48

    Facility

    $194.69

    $22.64 lower than Redding for the office setting.

  • Galveston

    Texas · 46221

    Office

    $322.55

    Facility

    $194.85

    $21.57 lower than Redding for the office setting.

  • Houston

    Texas · 46221

    Office

    $329.14

    Facility

    $201.44

    $14.98 lower than Redding for the office setting.

  • Rest Of Texas

    Texas · 46221

    Office

    $312.41

    Facility

    $190.38

    $31.71 lower than Redding for the office setting.

  • Utah

    Utah · 46221

    Office

    $310.22

    Facility

    $189.35

    $33.90 lower than Redding for the office setting.

  • Virginia

    Virginia · 46221

    Office

    $318.10

    Facility

    $191.69

    $26.02 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 46221

    Office

    $328.08

    Facility

    $198.08

    $16.04 lower than Redding for the office setting.

  • Vermont

    Vermont · 46221

    Office

    $317.35

    Facility

    $190.04

    $26.77 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 46221

    Office

    $336.33

    Facility

    $200.93

    $7.79 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 46221

    Office

    $381.06

    Facility

    $223.27

    $36.94 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 46221

    Office

    $307.39

    Facility

    $184.20

    $36.73 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 46221

    Office

    $299.82

    Facility

    $188.07

    $44.30 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 46221

    Office

    $322.53

    Facility

    $193.94

    $21.59 lower than Redding for the office setting.

See how rates vary across the country

46221 · 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.

$286.44

$388.66

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$374.061
AL$290.841
AR$286.441
AZ$316.591
CA$344.12–$433.2029
CO$339.101
CT$347.951
DC$373.321
DE$321.991
FL$321.29–$353.753
GA$302.39–$332.102
GU$353.041
HI$353.041
IA$298.281
ID$300.381
IL$311.83–$342.954
IN$302.191
KS$296.961
KY$298.351
LA$297.92–$313.322
MA$337.00–$373.432
MD$328.28–$373.323
ME$302.17–$319.092
MI$306.61–$325.622
MN$324.061
MO$292.67–$314.323
MS$289.601
MT$325.631
NC$305.451
ND$318.521
NE$299.951
NH$333.871
NJ$351.68–$369.212
NM$308.421
NV$323.891
NY$310.25–$385.645
OH$305.151
OK$297.641
OR$321.14–$350.102
PA$305.58–$339.072
PR$328.081
RI$333.631
SC$305.861
SD$317.671
TN$298.541
TX$303.49–$338.188
UT$310.221
VA$318.10–$373.322
VI$328.081
VT$317.351
WA$336.33–$381.062
WI$307.391
WV$299.821
WY$322.531

Explore 46221 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 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 46221 in Redding, the physician’s office rate is $344.12 and the facility-setting rate is $203.18: a difference of $140.94.

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 46221 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$378.53

$344.12 × 110% = $378.53

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 46221 in Redding.

PPRRVU2026_Oct_nonQPP.csv

5,581

Code
46221
Physician work
2.30
Practice expense
7.09
Malpractice
0.36

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 46221 in Redding
ComponentRVULocality factorAdjusted
Physician work2.30× 1.0172.3391
Practice expense7.09× 1.0967.7706
Malpractice0.36× 0.5360.1930
Total RVUs10.3027
Conversion factor× 33.4009

Office / nonfacility rate, Redding$344.12

Open 46221 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.31.017
Practice expense7.091.096
Malpractice0.360.536

(2.3 × 1.017 + 7.09 × 1.096 + 0.36 × 0.536) × $33.4009 = $344.12

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.31.017
Practice expense3.241.096
Malpractice0.360.536

(2.3 × 1.017 + 3.24 × 1.096 + 0.36 × 0.536) × $33.4009 = $203.18

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

46221 · Office / nonfacility

$344.12

Effective 2026-10-01

The base rate is $51.60 higher than on 2025-10-01, moving from $292.52 to $344.12 (17.6%).

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

    $292.52changed to$344.12

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.36 changed to 2.30
    • Practice expense RVU 5.90 changed to 7.09
    • 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: $292.52

    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$344.12$203.18RVU26D
2026-07-01$344.12$203.18RVU26C
2026-04-01$344.12$203.18RVU26B
2026-01-01$344.12$203.18RVU26A
2025-10-01$292.52$196.00RVU25D
2025-07-01$292.52$196.00RVU25C
2025-04-01$292.52$196.00RVU25B
2025-01-01$292.52$196.00RVU25A

46221 billing questions

Does 46221 cover one band or multiple bands?

The code covers rubber-band ligation of internal hemorrhoid tissue, including when multiple sites are treated in the session. Document the treated internal tissue and technique rather than reporting a separate unit for each band.

How is this different from excisional hemorrhoidectomy?

46221 describes rubber-band ligation of internal hemorrhoids. Codes such as 46255 and 46260 describe excision, with the applicable code depending on the tissue and extent removed.

Are related postoperative visits separately reported?

Related postoperative visits during the 10-day global period are included in 46221.

Can modifier 50 be used when hemorrhoids are treated on both sides?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.

How does Medicare handle other procedures performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50% when performed in the same session.

Can an assistant or co-surgeon be billed for the ligation?

Medicare does not pay an assistant at surgery for 46221. Co-surgeon and team-surgery billing 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 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 46221PPRRVU2026_Oct_nonQPP.csv, line 5,581 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet