$232.01–$257.91
Use 46221 when internal hemorrhoidal tissue is treated with rubber bands; 46930 describes thermal destruction.
On this page
CMS RVU26D · Effective 2026-10-01
46221 Hemorrhoid ligation Medicare reimbursement rates in Pennsylvania
Reports office or facility treatment of internal hemorrhoids by placing rubber bands around hemorrhoidal tissue to reduce its blood supply. Compare 46221 office and facility rates across CMS payment localities in Pennsylvania.
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 46221 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$305.58–$339.07
2 of 2 localities have a supported rate.
Facility setting
$187.53–$205.21
2 of 2 localities have a supported rate.
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 procedures
About 46221: Internal hemorrhoid rubber-band ligation
Reports office or facility treatment of internal hemorrhoids by placing rubber bands around hemorrhoidal tissue to reduce its blood supply.
This procedure treats internal hemorrhoids by placing a tight rubber band around the base of hemorrhoidal tissue, typically with an anoscope for visualization. Colorectal surgeons, general surgeons, and gastroenterologists commonly perform it in an outpatient office or facility for symptomatic internal hemorrhoids, such as those causing bleeding or prolapse. The service is for ligation by rubber band, not removal of external hemorrhoids or excision of hemorrhoidal tissue.
Report 46221 for the band-ligation service, including when more than one internal hemorrhoid is treated in the session; document the indication, internal site, technique, and treated tissue. Related postoperative visits for 10 days are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46221
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU2.30 · 24%
- Practice expense (office) RVU7.09 · 73%
- Malpractice RVU0.36 · 4%
68.8K
Medicare services in 2024 · #679 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.
46221 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Both treat internal hemorrhoids by ligation, but 46945 is for ligation by a method other than rubber-band ligation.
$547.29–$605.56
46221 is band ligation of internal tissue. 46255 describes excision of an internal and external hemorrhoid group.
$504.84–$559.84
46250 is excision of multiple external hemorrhoid groups; 46221 treats internal hemorrhoids by rubber-band ligation.
Compare 46221 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$339.07
Facility
$205.21
Rest Of Pennsylvania →
Office / nonfacility
$305.58
Facility
$187.53
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46221 billing questions
Does 46221 cover one band or multiple bands?
The code covers rubber-band ligation of internal hemorrhoid tissue, including when multiple sites are treated in the session. Document the treated internal tissue and technique rather than reporting a separate unit for each band.
How is this different from excisional hemorrhoidectomy?
46221 describes rubber-band ligation of internal hemorrhoids. Codes such as 46255 and 46260 describe excision, with the applicable code depending on the tissue and extent removed.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in 46221.
Can modifier 50 be used when hemorrhoids are treated on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
How does Medicare handle other procedures performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be billed for the ligation?
Medicare does not pay an assistant at surgery for 46221. 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 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.
5,57846083,,Inc thrombosed hroid xtrnl,A,,1.41,5.06,,1.53,,0.28,6.75,3.22,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,57946200,,Removal of anal fissure,A,,3.50,11.79,,6.31,,0.60,15.89,10.41,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58046220,,Excise anal ext tag/papilla,A,,1.57,6.39,,1.72,,0.29,8.25,3.58,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58146221,,Ligation of hemorrhoid(s),A,,2.30,7.09,,3.24,,0.36,9.75,5.90,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58246230,,Removal of anal tags,A,,2.55,7.22,,1.95,,0.48,10.25,4.98,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58346250,,Remove ext hem groups 2+,A,,4.14,11.09,,4.56,,0.84,16.07,9.54,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58446255,,Remove int/ext hem 1 group,A,,4.84,11.64,,4.75,,0.91,17.39,10.50,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00