$317.61
This code targets an anal sphincter muscle for chemodenervation. Code 46500 describes injection treatment directed at hemorrhoids.
On this page
CMS RVU26D · Effective 2026-10-01
46505 Anal chemodenervation Medicare reimbursement rates in Alabama
Reports injection to relax an anal sphincter muscle, commonly using botulinum toxin to treat a chronic anal fissure or sphincter spasm. Compare 46505 office and facility rates across CMS payment localities in Alabama.
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 46505 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$307.12
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$222.95
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
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.
Colorectal procedure
About 46505: Anal sphincter chemodenervation injection
Reports injection to relax an anal sphincter muscle, commonly using botulinum toxin to treat a chronic anal fissure or sphincter spasm.
This procedure delivers a chemical agent, commonly botulinum toxin, into an anal sphincter muscle to reduce muscle activity. Colorectal surgeons and other clinicians experienced in anorectal procedures use it most often for chronic anal fissure when sphincter relaxation is part of treatment. It may be performed in an office or facility, depending on the patient and procedural setting.
Report the injection service, not the toxin itself. Documentation should identify the indication, injected muscle, agent and dose, and injection details. When the practice supplies a separately reportable toxin, report its drug code and units in addition to the procedure as supported by the record. CMS assigns a 10-day global period, so related postoperative visits during that period are included. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. CMS rules also restrict assistant-at-surgery payment and do not permit co-surgeons or team surgery.
CMS billing rules for 46505
- 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 RVU3.10 · 30%
- Practice expense (office) RVU6.61 · 64%
- Malpractice RVU0.55 · 5%
1.6K
Medicare services in 2024 · #2636 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.
46505 compared with similar codes
Office rates for Alabama, from the same CMS release.
$472.82
Use this code for chemical relaxation of an anal sphincter muscle. Code 46200 describes operative fissure treatment rather than an injection.
$114.24
Anoscopy examines the anal canal with a scope; it does not describe injection of a chemical agent into an anal sphincter muscle.
Compare 46505 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.
1 of 1 payment localities
Alabama →
Office / nonfacility
$307.12
Facility
$222.95
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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 46505 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
5,597
- Code
- 46505
- Physician work
- 3.10
- Practice expense
- 6.61
- Malpractice
- 0.55
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.10 | × 1.000 | 3.1000 |
| Practice expense | 6.61 | × 0.875 | 5.7838 |
| Malpractice | 0.55 | × 0.566 | 0.3113 |
| Total RVUs | 9.1951 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$307.12
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.1 | 1 |
| Practice expense | 6.61 | 0.875 |
| Malpractice | 0.55 | 0.566 |
(3.1 × 1 + 6.61 × 0.875 + 0.55 × 0.566) × $33.4009 = $307.12
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.1 | 1 |
| Practice expense | 3.73 | 0.875 |
| Malpractice | 0.55 | 0.566 |
(3.1 × 1 + 3.73 × 0.875 + 0.55 × 0.566) × $33.4009 = $222.95
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.
46505 billing questions
When is this code appropriate for an anal fissure?
Use it when a chemical agent is injected into an anal sphincter muscle to reduce muscle activity, commonly as treatment for a chronic fissure. A surgical fissure procedure such as 46200 describes a different method.
Is the botulinum toxin included in the procedure code?
The code represents the injection service. When the practice supplies a separately reportable toxin, report the applicable drug code and documented units separately.
Can modifier 50 be used for injections on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not append modifier 50.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure's payment.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, while other procedures in that session are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment is restricted, and 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 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.
5,59446288,,Repair anal fistula,A,,7.61,7.50,NA,7.50,,1.43,16.54,16.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59546320,,Removal of hemorrhoid clot,A,,1.60,5.08,,1.36,,0.28,6.96,3.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59646500,,Injection into hemorrhoid(s),A,,1.70,8.75,,3.85,,0.27,10.72,5.82,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59746505,,Chemodenervation anal musc,A,,3.10,6.61,,3.73,,0.55,10.26,7.38,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59846600,,Diagnostic anoscopy spx,A,,0.54,3.24,,0.59,,0.08,3.86,1.21,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59946601,,Diagnostic anoscopy,A,,1.56,3.20,,0.79,,0.21,4.97,2.56,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60046604,,Anoscopy and dilation,A,,1.00,19.51,,0.69,,0.18,20.69,1.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515