Billing code 46946: Hemorrhoid ligationMedicare rate & RVUs in Ohio
Reports surgical ligation of at least two internal hemorrhoids without imaging guidance, rather than single-hemorrhoid ligation or Doppler-guided dearterialization.
CMS doesn’t publish an office rate for 46946 in Ohio.
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 46946 covers
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.
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 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $365.27 |
How the 46946 rate is calculated
Each of 46946’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 · 46946
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.39Practice expense 6.43Malpractice 0.67
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46946
46946 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46946
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 · 46946
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
46946 without 51 · national facility
$383.78
Hemorrhoid ligation
46946-51 · Second procedure: 50%
$191.89
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%).
46946 compared with similar codes
Compare codes
46946 vs 46945 vs 46948 vs 46930 vs 46947: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46945Hemorrhoid ligation
- Use 46945 when one internal hemorrhoid is treated by ligation without imaging guidance; use 46946 when two or more are treated.
- 46948Hemorrhoid surgery
- 46948 describes transanal hemorrhoidal dearterialization with imaging guidance. This code is for ligation of multiple hemorrhoids without imaging guidance.
- 46930Hemorrhoid treatment
- 46930 describes destruction of internal hemorrhoids, not the surgical ligation represented by 46946.
- 46947Hemorrhoidopexy
- 46947 is for stapled hemorrhoidopexy, a distinct operative method rather than ligation of multiple internal hemorrhoids.
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 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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