Billing code 46261: HemorrhoidectomyMedicare rate & RVUs in Missouri
Reports excision of internal and external hemorrhoidal disease in two or more groups when an anal fissure is also excised during the operation.
CMS doesn’t publish an office rate for 46261 in Missouri.
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 46261 covers
Code 46261 represents excision of internal and external hemorrhoidal disease involving two or more columns or groups, performed with excision of an anal fissure. A colorectal or general surgeon typically performs the operation in an operating room for symptomatic hemorrhoids requiring excision when a fissure is also treated surgically.
Report it when the operative record supports both the multiple-group hemorrhoidectomy and fissurectomy; document the number of groups and the fissure treatment. The fissurectomy is part of this combined service, so do not separately report 46200 for that same fissure. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. 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 46261 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $501.19 |
| Metropolitan St. Louis | Unavailable | $505.18 |
| Rest Of Missouri | Unavailable | $484.53 |
How the 46261 rate is calculated
Each of 46261’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 · 46261
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.57Practice expense 6.42Malpractice 1.44
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46261
46261 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46261
Hemorrhoidectomy
| 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 · 46261
Hemorrhoidectomy
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
46261 without 51 · national facility
$515.38
Hemorrhoidectomy
46261-51 · Second procedure: 50%
$257.69
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%).
46261 compared with similar codes
Compare codes
46261 vs 46257 vs 46260 vs 46262 vs 46200: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46257Hemorrhoidectomy
- Both include fissurectomy, but 46257 applies to one hemorrhoidal group. 46261 requires two or more groups.
- 46260Hemorrhoidectomy
- Both cover internal and external hemorrhoidectomy involving two or more groups. 46261 also includes fissurectomy; 46260 does not.
- 46262Hemorrhoidectomy
- This code pairs the multiple-group hemorrhoidectomy with fistulectomy. 46261 pairs it with fissurectomy.
- 46200Fissure surgery
- 46200 is for fissure excision without the combined multiple-group hemorrhoidectomy reported by 46261.
46261 billing questions
How does 46261 differ from 46257?
Both include hemorrhoidectomy with fissurectomy. Use 46261 for two or more hemorrhoidal groups; 46257 is for one group.
Can the fissurectomy also be reported as 46200?
Do not separately report 46200 for the fissure excised as part of the 46261 operation.
When is 46260 a better choice?
Use 46260 for internal and external hemorrhoidectomy involving two or more groups when the operation does not include fissurectomy.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports 46261?
The operative note should describe internal and external hemorrhoidal disease, the two-or-more group extent, and the fissure excision.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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