CPT 46604 Fee Schedule
Last Updated: August 2025
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 11 - Office • 24 - Ambulatory Surgical Center • 22 - On Campus-Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure or service by same physician during postoperative period |
| Complexity Level | Moderate |
National average reimbursement for CPT 46604 by major payers:
$678.17
$782.46
$895.83
$1,029.22
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Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 46604. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 46604 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.
CPT 46604 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 46604 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 46604 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 46600 | Low | Anoscopy; Diagnostic Including Collection Of Specimen(S) By Brushing Or Washing When Performed(Separate Procedure) (Desc Revised 01/01/15) |
| 46604 | Moderate | Anoscopy W Dilation Direct |
| 46606 | Moderate | Anoscopy; For Biopsy |
| 46607 | Moderate | Anoscopy, Diagnostic With High-Resolution Magnification (Hra) (Eg, Colposcope, Operating Microscope) And Chemical Agent Enhancement, With Biopsy, Single Or Multiple |
See what providers are getting paid in 2025 for 46604:
CPT 46604 Fee Schedule & Reimbursement Rates
The CPT 46604 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. BCBS National Rate | More Info |
|---|---|---|---|
| 46600 | $117.84 | $119.95 | |
| 46604 | $639.45 | $678.17 | |
| 46606 | $279.62 | $290.28 | |
| 46607 | $207.38 | $337.03 | |
| 46612 | $330.21 | $348.39 | |
| 46614 | $168.10 | $188.91 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is Price Transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
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