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See a sample rate comparisonCPT 46604 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.
Exam Of Anus With Scope, Examination Of The Anus Using A Scope To View The Anal Canal. The Procedure Includes Widening Of The Anal Canal.
| 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 - postop period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 46604 |
| Medicaid Fee Schedule | View Medicaid rates for 46604 |
National average reimbursement for CPT 46604 by major payers:
$678.17
$782.46
$895.83
$197.71
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CPT 46604
5 of 25 sample ratesHigher to lower in this preview
Medical City Surgery Center North Texas, LLC
$1,749.00Published rateDestin Surgery Center LLC
$1,179.00Published rateUnited Shockwave Services, Ltd., United Therapies
$704.00Published rateAesculapian Surgery Center, LLC, Intercoastal Medical Group Ambulatory Surgery Center
Aesculapian Surgery Center LLC
$559.00Published rateEye Care Surgery Center Of Memphis, LLC
$336.00Published rate
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See a sample payer proposalCPT 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.
| Code | Complexity | Description |
|---|---|---|
| 46600-CPT | Low | Rectal Exam With Scope, An Exam Of The Anus And Rectum Using A Scope (Anoscopy). The Procedure May Take A Sample Of Tissue For Testing (Biopsy). |
| 46604-CPT | Moderate | Exam Of Anus With Scope, Examination Of The Anus Using A Scope To View The Anal Canal. The Procedure Includes Widening Of The Anal Canal. |
| 46606-CPT | Moderate | Rectal Exam With Scope, An Exam Of The Anus And Rectum Using A Scope (Anoscopy). The Procedure May Take A Sample Of Tissue For Testing (Biopsy). |
| 46607-CPT | Moderate | Diagnostic Anoscopy Biopsy, Anoscopy With High Resolution Magnification Hra Eg Colposcope Operating Microscope And Chemical Agent Enhancement With Biopsy Single Or Multiple |
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.
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