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See a sample rate comparisonCPT 46258 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Remove In Ex Hem Grp W Fistu, Hemorrhoidectomy Internal And External Single Column Group With Fistulectomy Including Fissurectomy When Performed
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46258 |
| Medicaid Fee Schedule | View Medicaid rates for 46258 |
National average reimbursement for CPT 46258 by major payers:
$590.97
$613.69
$654.83
$762.16
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CPT 46258
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, LLC, Multispecialty Surgery Center
$8,705.00Published rateBellaire Outpatient Surgery Center, LLP, Baylor Scott & White Surgicare - Oakmont
Bellaire Outpatient Surgery Center LLP
$3,500.00Published rateRivers Edge Aesthetic Surgery, LLC
Rivers Edge Aesthetic Surgery LLC
$1,700.00Published rateThe Physicians Rome Surgery Center
$1,080.00Published rateTaylor Surgery Center, LLC, Surgical Arts Surgery Center
Taylor Surgery Center LLC
$654.00Published rate
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See a sample payer proposalCPT 46258 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46258 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 46258 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 46255-CPT | Moderate | Hemorrhoid Surgery, Surgery To Remove One Or More Internal Or External Hemorrhoids. The Procedure May Include Repairing Nearby Tissue. |
| 46257-CPT | Moderate | Hemorrhoid Surgery, Surgery To Remove One Or More Internal Or External Hemorrhoids. The Procedure May Include Repairing Nearby Tissue. |
| 46258-CPT | Moderate | Remove In Ex Hem Grp W Fistu, Hemorrhoidectomy Internal And External Single Column Group With Fistulectomy Including Fissurectomy When Performed |
| 46261-CPT | Moderate | Hemorrhoid Surgery, Surgery To Remove One Or More Internal Or External Hemorrhoids. The Procedure May Include Repairing Nearby Tissue. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46258. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46258 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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