Billing code 46948: Hemorrhoid surgeryMedicare rate & RVUs in Oregon
Reports transanal Doppler-guided surgery to reduce blood flow to two or more internal hemorrhoid columns or groups during one operative session.
CMS doesn’t publish an office rate for 46948 in Oregon.
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 46948 covers
The surgeon passes a Doppler probe through the anus to locate arterial branches supplying internal hemorrhoids, then places sutures to reduce blood flow. This technique treats two or more internal hemorrhoid columns or groups, often in patients with bleeding or prolapse. Colorectal and general surgeons typically perform it in an operating room or ambulatory surgery center.
Report this code for the transanal dearterialization technique with ultrasound guidance, not for hemorrhoid ligation or stapling performed by another method. The operative note should identify the technique and document treatment of at least two internal columns or groups. Guidance is part of the service. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the 90-day global period. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate; Medicare does not pay an assistant at surgery, 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.
Where 46948 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $464.43 |
| Rest Of Oregon | Unavailable | $433.84 |
How the 46948 rate is calculated
Each of 46948’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 · 46948
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.43Practice expense 6.82Malpractice 1.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 46948
46948 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 46948
Hemorrhoid surgery
| 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 · 46948
Hemorrhoid surgery
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
46948 without 51 · national facility
$445.57
Hemorrhoid surgery
46948-51 · Second procedure: 50%
$222.79
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%).
46948 compared with similar codes
Compare codes
46948 vs 46946 vs 46945 vs 46947 vs 46930: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 46946Hemorrhoid ligation
- Choose 46948 when the surgeon performs transanal Doppler-guided dearterialization. Code 46946 describes ligation of two or more columns by another technique.
- 46945Hemorrhoid ligation
- Code 46945 is for ligation of one internal hemorrhoid column by another technique; 46948 requires transanal Doppler-guided dearterialization of at least two columns or groups.
- 46947Hemorrhoidopexy
- Code 46947 describes stapled hemorrhoidopexy for prolapsing internal hemorrhoids, not Doppler-guided dearterialization.
- 46930Hemorrhoid treatment
- Code 46930 describes destruction of internal hemorrhoids. Use 46948 for the specified transanal Doppler-guided dearterialization technique.
46948 billing questions
How does this differ from code 46946?
Code 46948 describes transanal dearterialization using Doppler guidance. Code 46946 is for internal hemorrhoid ligation by a different technique.
Is Doppler guidance separately reportable?
No. The guidance is included in this service.
How many units should be reported?
The code covers treatment of two or more internal hemorrhoid columns or groups. Do not report a separate unit for each column.
Should modifier 50 be appended?
No. The service is defined by the number of hemorrhoid columns or groups treated, not by bilateral anatomy.
What should the operative note document?
Document the transanal Doppler-guided technique and identify treatment of at least two internal hemorrhoid columns or groups.
Can an assistant or co-surgeon be billed to Medicare?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing 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
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