Billing code 46500: Hemorrhoid injectionMedicare rate & RVUs in Delaware
Injection of a sclerosing agent into internal hemorrhoids to treat symptomatic hemorrhoidal disease is reported for office or outpatient treatment.
Medicare pays $353.92 for 46500 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 46500 covers
This service involves injecting a sclerosing agent into internal hemorrhoidal tissue, commonly to address bleeding or prolapsing hemorrhoids. A colorectal or general surgeon, or another clinician trained in anorectal procedures, may perform it in an office or outpatient setting. It is distinct from injecting medication into the anal sphincter, which targets a different condition and structure.
Documentation should identify the symptoms and examination findings supporting treatment, the hemorrhoid(s) treated, and the injection procedure performed. CMS assigns different practice-expense inputs for office and facility settings. The service has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate. Medicare does not pay an assistant at surgery, and co-surgeon or team-surgery reporting is not permitted.
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.
46500 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $353.92 | $192.22 |
How the 46500 rate is calculated
Each of 46500’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 46500
RVUs × geographic indexes × conversion factor
Work1.70
1.70 RVUs× 1.000 GPCI
Practice expense8.75
8.75 RVUs× 1.000 GPCI
Malpractice0.27
0.27 RVUs× 1.000 GPCI
Adjusted RVUs
10.7200
Conversion factor
$33.4009
Medicare rate
$358.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46500
46500 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46500
Hemorrhoid injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46500
Hemorrhoid injection
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46500 without 51 · national office
$358.06
Hemorrhoid injection
46500-51 · Second procedure: 50%
$179.03
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
46500 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 46221Hemorrhoid ligation
- Use 46500 for injection of a sclerosing agent; use 46221 when hemorrhoids are treated by rubber-band ligation.
- 46930Hemorrhoid treatment
- 46500 describes injection treatment. Code 46930 describes destruction of internal hemorrhoids using thermal energy.
- 46505Anal chemodenervation
- 46500 targets hemorrhoidal tissue. Code 46505 targets the anal sphincter muscle for chemodenervation, such as treatment of sphincter spasm.
- 46255Hemorrhoidectomy
- 46500 is an injection treatment; 46255 describes surgical excision of internal and external hemorrhoidal tissue in a single column or group.
46500 billing questions
When should 46500 be chosen instead of hemorrhoid banding?
Report 46500 when a sclerosing agent is injected into hemorrhoidal tissue. Rubber-band ligation is a different treatment method reported with 46221.
Is the code reported once for each hemorrhoid or injection?
The code describes injection treatment of hemorrhoid(s). Document the treated site or sites and the service performed; do not create separate units for individual needle passes.
Are related postoperative visits separately reported during the global period?
Related postoperative visits during the 10-day global period are included in the procedure payment.
Can modifier 50 be used when hemorrhoids are treated on both sides?
No. Modifier 50 is not appropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeon and team-surgery reporting 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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