Billing code 46505: Anal chemodenervationMedicare rate & RVUs in Guam
Reports injection to relax an anal sphincter muscle, commonly using botulinum toxin to treat a chronic anal fissure or sphincter spasm.
Medicare pays $365.21 for 46505 in the office in Guam (Hawaii, Guam). 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 46505 covers
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.
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 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $365.21 | $255.83 |
How the 46505 rate is calculated
Each of 46505’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 · 46505
RVUs × geographic indexes × conversion factor
Work3.10
3.10 RVUs× 1.000 GPCI
Practice expense6.61
6.61 RVUs× 1.000 GPCI
Malpractice0.55
0.55 RVUs× 1.000 GPCI
Adjusted RVUs
10.2600
Conversion factor
$33.4009
Medicare rate
$342.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 46505
46505 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46505
Anal chemodenervation
| 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 · 46505
Anal chemodenervation
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
46505 without 51 · national office
$342.69
Anal chemodenervation
46505-51 · Second procedure: 50%
$171.35
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%).
46505 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 46500Hemorrhoid injection
- This code targets an anal sphincter muscle for chemodenervation. Code 46500 describes injection treatment directed at hemorrhoids.
- 46200Fissure surgery
- Use this code for chemical relaxation of an anal sphincter muscle. Code 46200 describes operative fissure treatment rather than an injection.
- 46600Diagnostic anoscopy
- Anoscopy examines the anal canal with a scope; it does not describe injection of a chemical agent into an anal sphincter muscle.
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 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
Fee sheets
Put 46505 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →