$606.81–$756.36
Choose 46255 for excision of one internal and external hemorrhoid group without fistulectomy. The fistulectomy is the distinguishing work in 46258.
On this page
CMS RVU26D · Effective 2026-10-01
46258 Hemorrhoidectomy Medicare reimbursement rates in California
Reports excision of one internal and external hemorrhoid group together with fistulectomy during the same operative session. Compare 46258 office and facility rates across CMS payment localities in California.
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 46258 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$479.42–$573.72
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $94.30 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 46258 pays more and less in California
Colorectal surgery
About 46258: Single-group hemorrhoidectomy with fistulectomy
Reports excision of one internal and external hemorrhoid group together with fistulectomy during the same operative session.
This service combines excision of one internal and external hemorrhoid group with surgical removal of an anal fistula. It is typically performed by a colorectal surgeon or general surgeon in an operating room or ambulatory surgery center when both conditions are treated in the same operation. The hemorrhoid component is limited to one column or group; the fistulectomy is part of the service described by this code.
Select this code when the operative report supports treatment of one hemorrhoid group and fistulectomy, rather than fissurectomy or treatment of multiple groups. Document the hemorrhoid site and extent, the fistula treated, and the procedures actually performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and additional procedures at 50%. Modifier 50 is inappropriate for this single-group service. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 46258
- 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.25 · 43%
- Practice expense (office) RVU6.48 · 45%
- Malpractice RVU1.67 · 12%
44
Medicare services in 2024 · #5435 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.
46258 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
46257 combines single-group hemorrhoidectomy with fissurectomy. 46258 combines it with fistulectomy.
No office rate
Both include fistulectomy, but 46262 is for removal of two or more internal and external hemorrhoid groups; 46258 is for one.
$626.29–$781.84
46270 covers fistulectomy for a subcutaneous fistula without the combined single-group hemorrhoidectomy reported by 46258.
Compare 46258 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.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $483.91 |
| Chico | Office Unavailable | Facility $479.42 |
| El Centro | Office Unavailable | Facility $479.70 |
| Fresno | Office Unavailable | Facility $479.42 |
| Hanford-Corcoran | Office Unavailable | Facility $479.42 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $510.40 |
| Madera | Office Unavailable | Facility $479.42 |
| Merced | Office Unavailable | Facility $479.42 |
| Modesto | Office Unavailable | Facility $479.42 |
| Napa | Office Unavailable | Facility $535.51 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $505.18 |
| Redding | Office Unavailable | Facility $479.42 |
| Rest Of California | Office Unavailable | Facility $479.42 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $497.31 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $497.89 |
| Salinas | Office Unavailable | Facility $495.98 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $504.11 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $559.37 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $557.47 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $573.72 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $565.97 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $488.72 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $506.01 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $496.87 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $510.70 |
| Stockton | Office Unavailable | Facility $479.42 |
| Vallejo | Office Unavailable | Facility $532.78 |
| Visalia | Office Unavailable | Facility $479.42 |
| Yuba City | Office Unavailable | Facility $479.42 |
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46258 billing questions
How does this differ from 46255?
46258 includes fistulectomy with removal of one internal and external hemorrhoid group. Use 46255 when that group is removed without fistulectomy.
When is 46257 a better fit?
46257 pairs single-group hemorrhoidectomy with fissurectomy. This code is for the combination with fistulectomy instead.
How many hemorrhoid groups does this code cover?
It describes one internal and external hemorrhoid column or group. When two or more groups are removed with fistulectomy, compare 46262.
What should the operative note support?
Document the single hemorrhoid group excised, the fistula treated, and the operative work performed. The record should make clear that fistulectomy occurred during the same session.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon and team-surgery payment are not permitted for this service.
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.
5,58346250,,Remove ext hem groups 2+,A,,4.14,11.09,,4.56,,0.84,16.07,9.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58446255,,Remove int/ext hem 1 group,A,,4.84,11.64,,4.75,,0.91,17.39,10.50,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58546257,,Remove in/ex hem grp & fiss,A,,5.62,6.02,NA,6.02,,0.81,12.45,12.45,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58646258,,Remove in/ex hem grp w/fistu,A,,6.25,6.48,NA,6.48,,1.67,14.40,14.40,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58746260,,Remove in/ex hem groups 2+,A,,6.56,6.46,NA,6.46,,1.34,14.36,14.36,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58846261,,Remove in/ex hem grps & fiss,A,,7.57,6.42,NA,6.42,,1.44,15.43,15.43,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58946262,,Remove in/ex hem grps w/fist,A,,7.71,7.83,NA,7.83,,2.06,17.60,17.60,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00