$547.29–$605.56
Both address one internal and external hemorrhoid group; choose 46257 when fissurectomy is also performed, and 46255 when it is not.
On this page
CMS RVU26D · Effective 2026-10-01
46257 Hemorrhoidectomy Medicare reimbursement rates in Pennsylvania
Report this operation when a surgeon excises one internal and external hemorrhoid group and performs a fissurectomy during the same session. Compare 46257 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 46257 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
No supported rate
Facility setting
$397.87–$432.69
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.
Colorectal surgery
About 46257: Single-group hemorrhoidectomy with fissurectomy
Report this operation when a surgeon excises one internal and external hemorrhoid group and performs a fissurectomy during the same session.
This operation removes one hemorrhoidal group with both internal and external components and includes excision of an anal fissure. It is typically performed by a colorectal or general surgeon in an operating room, with the operative report documenting the treated hemorrhoid group and the fissurectomy performed during the operation.
Choose this code when the work includes both the single-group hemorrhoidectomy and fissurectomy; a fissure’s presence alone does not support reporting the combined procedure if fissurectomy was not performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed 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 service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46257
- 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 RVU5.62 · 45%
- Practice expense (office) RVU6.02 · 48%
- Malpractice RVU0.81 · 7%
54
Medicare services in 2024 · #5311 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.
46257 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
No office rate
Both include fissurectomy, but 46261 is for multiple hemorrhoid groups rather than one.
No office rate
46258 combines hemorrhoid surgery with treatment of an anal fistula; 46257 combines one-group hemorrhoidectomy with fissurectomy.
$497.35–$552.86
46200 covers fissure removal without the combined hemorrhoidectomy. Use 46257 when the operation also removes one internal and external hemorrhoid group.
Compare 46257 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
Unavailable
Facility
$432.69
Rest Of Pennsylvania →
Office / nonfacility
Unavailable
Facility
$397.87
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
46257 billing questions
How does this differ from 46255?
46257 includes fissurectomy with excision of one internal and external hemorrhoid group. 46255 describes the one-group hemorrhoidectomy without the fissurectomy.
Can the fissurectomy be billed separately?
The fissurectomy is included in this combined procedure. Do not separately report it as though it were an independent service performed during the same operation.
When is 46261 more appropriate?
Use 46261 when the operation treats multiple internal and external hemorrhoid groups and includes fissurectomy. This code is for one group with fissurectomy.
Should modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does the global period affect postoperative claims?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this service. 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.
5,58246230,,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
5,58546257,,Remove in/ex hem grp & fiss,A,,5.62,6.02,NA,6.02,,0.81,12.45,12.45,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58646258,,Remove in/ex hem grp w/fistu,A,,6.25,6.48,NA,6.48,,1.67,14.40,14.40,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58746260,,Remove in/ex hem groups 2+,A,,6.56,6.46,NA,6.46,,1.34,14.36,14.36,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,58846261,,Remove in/ex hem grps & fiss,A,,7.57,6.42,NA,6.42,,1.44,15.43,15.43,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00