CPT 46607
Global 000 ActiveDiagnostic anoscopy & biopsy
CPT 46607 Billing & Documentation Guide
CPT code 46607 (Diagnostic anoscopy & biopsy) is classified under Surgery (Digestive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.15, a non-facility practice expense RVU of 4.46, and a malpractice RVU of 0.3, a total non-facility RVU of 6.91 and facility RVU of 3.39. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $237.32, though rates vary from $204.94 to $299.89 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 46607, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 46607 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 46607 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 46607
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.15 | 2.15 |
| Practice Expense RVU | 4.46 | 0.94 |
| Malpractice RVU | 0.3 | 0.3 |
| Total RVU | 6.91 | 3.39 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 46607
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $256.09 | $116.97 | $241.67 - $299.89 | 29 |
| Florida | $240.78 | $122.82 | $229.29 - $252.23 | 3 |
| Georgia | $226.02 | $113.86 | $216.64 - $235.41 | 2 |
| Illinois | $235.15 | $121.55 | $223.48 - $245.02 | 4 |
| Michigan | $225.8 | $115.4 | $219.13 - $232.46 | 2 |
| North Carolina | $217.2 | $107.51 | $217.2 - $217.2 | 1 |
| New York | $255.03 | $123.87 | $220.38 - $272.14 | 5 |
| Ohio | $217.92 | $110.58 | $217.92 - $217.92 | 1 |
| Pennsylvania | $229.08 | $113.92 | $218.03 - $240.13 | 2 |
| Texas | $228.17 | $112.43 | $216.68 - $238.44 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 46607
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 46607 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00731 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00732 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00740 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00810 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00811 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00812 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00813 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00902 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 46607
What does CPT code 46607 mean? +
CPT code 46607 represents: Diagnostic anoscopy & biopsy. It's in the Surgery (Digestive) category with a global period of 000.
What is the Medicare reimbursement for CPT 46607? +
The 2026 Medicare national average non-facility payment for CPT 46607 is $237.32. Rates range from $204.94 to $299.89 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 46607? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 46607? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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