No office rate
Choose 46948 when the surgeon performs transanal Doppler-guided dearterialization. Code 46946 describes ligation of two or more columns by another technique.
On this page
CMS RVU26D · Effective 2026-10-01
46948 Hemorrhoid surgery Medicare reimbursement rates in Delaware
Reports transanal Doppler-guided surgery to reduce blood flow to two or more internal hemorrhoid columns or groups during one operative session. Compare 46948 office and facility rates across CMS payment localities in Delaware.
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 46948 in Delaware?
Delaware 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
No supported rate
Facility setting
$440.06
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Anorectal surgery
About 46948: Doppler-guided internal hemorrhoid surgery
Reports transanal Doppler-guided surgery to reduce blood flow to two or more internal hemorrhoid columns or groups during one operative session.
The surgeon passes a Doppler probe through the anus to locate arterial branches supplying internal hemorrhoids, then places sutures to reduce blood flow. This technique treats two or more internal hemorrhoid columns or groups, often in patients with bleeding or prolapse. Colorectal and general surgeons typically perform it in an operating room or ambulatory surgery center.
Report this code for the transanal dearterialization technique with ultrasound guidance, not for hemorrhoid ligation or stapling performed by another method. The operative note should identify the technique and document treatment of at least two internal columns or groups. Guidance is part of the service. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the 90-day global period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46948
- 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
- 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 RVU5.43 · 41%
- Practice expense (office) RVU6.82 · 51%
- Malpractice RVU1.09 · 8%
702
Medicare services in 2024 · #3258 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.
46948 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Code 46945 is for ligation of one internal hemorrhoid column by another technique; 46948 requires transanal Doppler-guided dearterialization of at least two columns or groups.
No office rate
Code 46947 describes stapled hemorrhoidopexy for prolapsing internal hemorrhoids, not Doppler-guided dearterialization.
$245.10
Code 46930 describes destruction of internal hemorrhoids. Use 46948 for the specified transanal Doppler-guided dearterialization technique.
Compare 46948 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
Delaware →
Office / nonfacility
Unavailable
Facility
$440.06
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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 46948 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,642
- Code
- 46948
- Physician work
- 5.43
- Practice expense
- 6.82
- Malpractice
- 1.09
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.43 | × 1.005 | 5.4571 |
| Practice expense | 6.82 | × 0.988 | 6.7382 |
| Malpractice | 1.09 | × 0.899 | 0.9799 |
| Total RVUs | 13.1752 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$440.06
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.43 | 1.005 |
| Practice expense | 6.82 | 0.988 |
| Malpractice | 1.09 | 0.899 |
(5.43 × 1.005 + 6.82 × 0.988 + 1.09 × 0.899) × $33.4009 = $440.06
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.
46948 billing questions
How does this differ from code 46946?
Code 46948 describes transanal dearterialization using Doppler guidance. Code 46946 is for internal hemorrhoid ligation by a different technique.
Is Doppler guidance separately reportable?
No. The guidance is included in this service.
How many units should be reported?
The code covers treatment of two or more internal hemorrhoid columns or groups. Do not report a separate unit for each column.
Should modifier 50 be appended?
No. The service is defined by the number of hemorrhoid columns or groups treated, not by bilateral anatomy.
What should the operative note document?
Document the transanal Doppler-guided technique and identify treatment of at least two internal hemorrhoid columns or groups.
Can an assistant or co-surgeon be billed to Medicare?
Medicare does not pay an assistant at surgery for this code. 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.
5,63946945,,Int hrhc lig 1 hroid w/o img,A,,3.60,6.27,NA,6.27,,0.62,10.49,10.49,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64046946,,Int hrhc lig 2+hroid w/o img,A,,4.39,6.43,NA,6.43,,0.67,11.49,11.49,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64146947,,Hemorrhoidopexy by stapling,A,,5.43,4.71,NA,4.71,,1.22,11.36,11.36,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64246948,,Int hrhc tranal dartlzj 2+,A,,5.43,6.82,NA,6.82,,1.09,13.34,13.34,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64346999,,Unlisted procedure anus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64447000,,Needle biopsy of liver perq,A,,1.61,6.84,,0.51,,0.17,8.62,2.29,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,64547001,,Ndl biopsy lvr tm oth maj px,A,,1.85,0.45,NA,0.45,,0.47,2.77,2.77,0,ZZZ,0.00,0.00,0.00,0,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503