No office rate
Both describe internal hemorrhoid ligation without imaging guidance; 46945 is for one column or group, while 46946 is for two or more.
On this page
CMS RVU26D · Effective 2026-10-01
46945 Hemorrhoid ligation Medicare reimbursement rates in Hawaii
Reports surgical ligation of one internal hemorrhoid column or group without imaging guidance, rather than destruction, stapling, or treatment of multiple columns. Compare 46945 office and facility rates across CMS payment localities in Hawaii.
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 46945 in Hawaii?
Hawaii 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
$370.35
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 46945: Internal hemorrhoid ligation, one column
Reports surgical ligation of one internal hemorrhoid column or group without imaging guidance, rather than destruction, stapling, or treatment of multiple columns.
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.
CMS billing rules for 46945
- 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 RVU3.60 · 34%
- Practice expense (office) RVU6.27 · 60%
- Malpractice RVU0.62 · 6%
1K
Medicare services in 2024 · #2933 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.
46945 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$270.50
Choose 46945 for ligation. Choose 46930 when internal hemorrhoids are destroyed rather than ligated.
No office rate
46945 is ligation of one internal hemorrhoid column or group. 46947 describes stapled hemorrhoidopexy, a distinct surgical method.
Compare 46945 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$370.35
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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 46945 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,639
- Code
- 46945
- Physician work
- 3.60
- Practice expense
- 6.27
- Malpractice
- 0.62
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.60 | × 1.000 | 3.6000 |
| Practice expense | 6.27 | × 1.137 | 7.1290 |
| Malpractice | 0.62 | × 0.579 | 0.3590 |
| Total RVUs | 11.0880 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$370.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.6 | 1 |
| Practice expense | 6.27 | 1.137 |
| Malpractice | 0.62 | 0.579 |
(3.6 × 1 + 6.27 × 1.137 + 0.62 × 0.579) × $33.4009 = $370.35
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.
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 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.
5,63646930,,Destroy internal hemorrhoids,A,,1.57,5.63,,2.93,,0.22,7.42,4.72,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63746940,,Treatment of anal fissure,A,,2.29,6.05,,1.45,,0.35,8.69,4.09,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,63846942,,Treatment of anal fissure,A,,2.02,6.01,,1.39,,0.29,8.32,3.70,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014