$134.26–$153.91
Use 46600 for diagnostic anoscopy without dilation. Report 46604 when the clinician dilates a narrowed anal canal during the examination.
On this page
CMS RVU26D · Effective 2026-10-01
46604 Anoscopy Medicare reimbursement rates in Washington
Report this service when the clinician examines the anal canal with an anoscope and dilates a narrowed area during the procedure. Compare 46604 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 46604 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
$724.60–$839.56
2 of 2 localities have a supported rate.
Facility setting
$62.68–$68.26
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 procedure
About 46604: Anoscopy with anal canal dilation
Report this service when the clinician examines the anal canal with an anoscope and dilates a narrowed area during the procedure.
A clinician advances an anoscope to inspect the anal canal and dilates a narrowed segment under direct visualization. Dilation may use a balloon, guidewire, or bougie. A typical indication is anal canal narrowing that makes passage difficult or limits examination. Colorectal surgeons and other clinicians who perform anorectal procedures may provide the service in an office or outpatient facility.
Report this code when the documented service includes both anoscopic examination and dilation; a diagnostic examination without dilation is a different service. The note should identify the narrowing and document the dilation performed and its method. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Do not use modifier 50. Medicare does not pay an assistant-at-surgery claim for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 46604
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- 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 RVU1.00 · 5%
- Practice expense (office) RVU19.51 · 94%
- Malpractice RVU0.18 · 1%
1.1K
Medicare services in 2024 · #2911 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.
46604 compared with similar codes
Office rates for Washington, from the same CMS release.
$319.71–$366.98
46606 describes anoscopy with biopsy. Choose it when tissue sampling is performed rather than dilation; document the actual intervention.
No office rate
45910 describes anal sphincter dilation under anesthesia other than local. It is distinct from dilation performed with anoscopy under 46604.
Compare 46604 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
$724.60
Facility
$62.68
Seattle (King Cnty) →
Office / nonfacility
$839.56
Facility
$68.26
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46604 billing questions
When should I report this instead of diagnostic anoscopy?
Report this code when the clinician performs dilation of a narrowed anal canal during anoscopy. A diagnostic examination without dilation points to 46600.
Can I report a biopsy separately when dilation is performed?
This code represents anoscopy with dilation, not biopsy. If the clinician also takes a biopsy, document the additional work and apply the applicable coding and endoscopy family pricing rules.
Should I append modifier 50?
No. Medicare's bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Is same-day evaluation and management work included?
The code has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant-at-surgery claim for this service. Co-surgeon and team-surgery billing are not permitted.
What documentation supports reporting dilation?
Document the anal canal narrowing and the dilation actually performed, including the method used. An anoscopic examination alone does not support this code.
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.
5,59746505,,Chemodenervation anal musc,A,,3.10,6.61,,3.73,,0.55,10.26,7.38,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59846600,,Diagnostic anoscopy spx,A,,0.54,3.24,,0.59,,0.08,3.86,1.21,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,59946601,,Diagnostic anoscopy,A,,1.56,3.20,,0.79,,0.21,4.97,2.56,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60046604,,Anoscopy and dilation,A,,1.00,19.51,,0.69,,0.18,20.69,1.87,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60146606,,Anoscopy and biopsy,A,,1.17,7.82,,0.76,,0.20,9.19,2.13,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60246607,,Diagnostic anoscopy & biopsy,A,,2.15,4.46,,0.94,,0.30,6.91,3.39,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00
5,60346608,,Anoscopy remove for body,A,,1.27,8.03,,0.82,,0.35,9.65,2.44,0,000,0.00,0.00,0.00,3,0,1,0,0,9,46600,33.4009,09,0,99,0.00,0.00,0.00