No office rate
Use 46945 when one internal hemorrhoid is treated by ligation without imaging guidance; use 46946 when two or more are treated.
On this page
CMS RVU26D · Effective 2026-10-01
46946 Hemorrhoid ligation Medicare reimbursement rates in Nebraska
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization. Compare 46946 office and facility rates across CMS payment localities in Nebraska.
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 46946 in Nebraska?
Nebraska 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
$353.32
1 of 1 localities have a supported rate.
Payment area: Nebraska
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.
Colorectal surgery
About 46946: Internal hemorrhoid ligation, multiple
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization.
A surgeon treats at least two internal hemorrhoids by ligating them without imaging guidance. This is a surgical approach, distinct from office rubber-band ligation and from Doppler-guided transanal hemorrhoidal dearterialization. Colorectal and general surgeons commonly perform it in an operating room or ambulatory surgery setting for symptomatic internal hemorrhoids when operative ligation is selected.
Choose this code when two or more hemorrhoids are treated during the procedure; use the single-hemorrhoid code when only one is treated. The operative report should support the number treated and the ligation method, including that imaging guidance was not used. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur 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. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46946
- 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 RVU4.39 · 38%
- Practice expense (office) RVU6.43 · 56%
- Malpractice RVU0.67 · 6%
2.1K
Medicare services in 2024 · #2416 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.
46946 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
46948 describes transanal hemorrhoidal dearterialization with imaging guidance. This code is for ligation of multiple hemorrhoids without imaging guidance.
$228.78
46930 describes destruction of internal hemorrhoids, not the surgical ligation represented by 46946.
No office rate
46947 is for stapled hemorrhoidopexy, a distinct operative method rather than ligation of multiple internal hemorrhoids.
Compare 46946 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
Nebraska →
Office / nonfacility
Unavailable
Facility
$353.32
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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 46946 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
5,640
- Code
- 46946
- Physician work
- 4.39
- Practice expense
- 6.43
- Malpractice
- 0.67
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.39 | × 1.000 | 4.3900 |
| Practice expense | 6.43 | × 0.923 | 5.9349 |
| Malpractice | 0.67 | × 0.378 | 0.2533 |
| Total RVUs | 10.5782 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nebraska$353.32
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.39 | 1 |
| Practice expense | 6.43 | 0.923 |
| Malpractice | 0.67 | 0.378 |
(4.39 × 1 + 6.43 × 0.923 + 0.67 × 0.378) × $33.4009 = $353.32
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.
46946 billing questions
When should I report this instead of 46945?
Report 46946 when at least two internal hemorrhoids are ligated in the procedure. Code 46945 is for treatment of a single hemorrhoid.
How does this differ from rubber-band ligation?
This code represents surgical ligation other than rubber-band ligation. Do not select it solely because multiple hemorrhoids were treated with office banding.
Is modifier 50 appropriate when hemorrhoids are on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What if another procedure is performed in the same session?
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 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.
5,63746940,,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
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
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068