Billing code 46945: Hemorrhoid ligationMedicare rate & RVUs in Florida
Reports surgical ligation of one internal hemorrhoid column or group without imaging guidance, rather than destruction, stapling, or treatment of multiple columns.
CMS doesn’t publish an office rate for 46945 in Florida.
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 46945 covers
This service treats one internal hemorrhoid column or group by ligation using a method other than rubber-band ligation. A surgeon, commonly a colorectal or general surgeon, performs the procedure in an operating room or another procedural setting, typically using visualization of the anal canal. The code distinguishes a single column or group from treatment of two or more columns and from procedures that destroy or reposition hemorrhoidal tissue.
Report 46945 when the operative documentation supports ligation of one internal hemorrhoid column or group without imaging guidance. Documentation should identify the treated hemorrhoid and describe the ligation technique; use the multiple-column code when two or more columns are treated. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate for this anatomy-specific service. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are 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.
Where 46945 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $369.83 |
| Miami | Unavailable | $390.63 |
| Rest Of Florida | Unavailable | $351.58 |
How the 46945 rate is calculated
Each of 46945’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 · 46945
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.60Practice expense 6.27Malpractice 0.62
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46945
46945 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46945
Hemorrhoid ligation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 46945
Hemorrhoid ligation
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
46945 without 51 · national facility
$350.38
Hemorrhoid ligation
46945-51 · Second procedure: 50%
$175.19
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%).
46945 compared with similar codes
Compare codes
46945 vs 46946 vs 46930 vs 46947: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46946Hemorrhoid ligation
- Both describe internal hemorrhoid ligation without imaging guidance; 46945 is for one column or group, while 46946 is for two or more.
- 46930Hemorrhoid treatment
- Choose 46945 for ligation. Choose 46930 when internal hemorrhoids are destroyed rather than ligated.
- 46947Hemorrhoidopexy
- 46945 is ligation of one internal hemorrhoid column or group. 46947 describes stapled hemorrhoidopexy, a distinct surgical method.
46945 billing questions
When should 46945 be used instead of 46946?
Use 46945 for ligation of one internal hemorrhoid column or group. When two or more columns are treated, use 46946.
How does this differ from 46930?
46945 describes ligation of an internal hemorrhoid column or group. 46930 is for destruction of internal hemorrhoids, a different treatment method.
What documentation supports reporting 46945?
The operative note should identify the internal hemorrhoid treated, support that one column or group was ligated, and describe the method used without imaging guidance.
Can modifier 50 be reported?
No. The anatomy and service descriptor make bilateral adjustment inappropriate for 46945.
How are related postoperative visits handled?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. 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 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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