No office rate
Both include fissurectomy, but 46257 applies to one hemorrhoidal group. 46261 requires two or more groups.
On this page
CMS RVU26D · Effective 2026-10-01
46261 Hemorrhoidectomy Medicare reimbursement rates in Washington
Reports excision of internal and external hemorrhoidal disease in two or more groups when an anal fissure is also excised during the operation. Compare 46261 office and facility rates across CMS payment localities in Washington.
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 46261 in Washington?
Washington 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
$518.53–$567.89
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 46261: Multiple-group hemorrhoidectomy with fissurectomy
Reports excision of internal and external hemorrhoidal disease in two or more groups when an anal fissure is also excised during the operation.
Code 46261 represents excision of internal and external hemorrhoidal disease involving two or more columns or groups, performed with excision of an anal fissure. A colorectal or general surgeon typically performs the operation in an operating room for symptomatic hemorrhoids requiring excision when a fissure is also treated surgically.
Report it when the operative record supports both the multiple-group hemorrhoidectomy and fissurectomy; document the number of groups and the fissure treatment. The fissurectomy is part of this combined service, so do not separately report 46200 for that same fissure. The 90-day global includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one 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; co-surgeons and team surgery are not permitted.
CMS billing rules for 46261
- 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 RVU7.57 · 49%
- Practice expense (office) RVU6.42 · 42%
- Malpractice RVU1.44 · 9%
185
Medicare services in 2024 · #4387 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.
46261 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
Both cover internal and external hemorrhoidectomy involving two or more groups. 46261 also includes fissurectomy; 46260 does not.
No office rate
This code pairs the multiple-group hemorrhoidectomy with fistulectomy. 46261 pairs it with fissurectomy.
$548.34–$622.31
46200 is for fissure excision without the combined multiple-group hemorrhoidectomy reported by 46261.
Compare 46261 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
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$518.53
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$567.89
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46261 billing questions
How does 46261 differ from 46257?
Both include hemorrhoidectomy with fissurectomy. Use 46261 for two or more hemorrhoidal groups; 46257 is for one group.
Can the fissurectomy also be reported as 46200?
Do not separately report 46200 for the fissure excised as part of the 46261 operation.
When is 46260 a better choice?
Use 46260 for internal and external hemorrhoidectomy involving two or more groups when the operation does not include fissurectomy.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports 46261?
The operative note should describe internal and external hemorrhoidal disease, the two-or-more group extent, and the fissure excision.
How are other procedures in the same session paid?
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.
5,58546257,,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
5,58946262,,Remove in/ex hem grps w/fist,A,,7.71,7.83,NA,7.83,,2.06,17.60,17.60,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59046270,,Remove anal fist subq,A,,4.80,12.17,,6.43,,0.99,17.96,12.22,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59146275,,Remove anal fist inter,A,,5.28,12.62,,6.47,,0.98,18.88,12.73,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00