46255
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
4.84
Facility
$350.71
Non-Facility
$580.84
Documentation Required
- Medical record documentation must show the diagnosis of Grade II or III hemorrhoids and that the patient failed prior rubber band ligation or conservative measures (behavior modification, high-fiber diet, topical hydrocortisone cream/suppositories).
- Claims for the procedure must be submitted using CPT code 46948 on the claim form.
Key Coverage Criteria
- Doppler-guided hemorrhoid artery ligation, with or without retroanal repair, is a covered service.
- Coverage is limited to patients with Grade II hemorrhoids.
- Coverage is limited to patients with Grade III hemorrhoids.
- Hemorrhoid artery ligation is covered only after failure of rubber band ligation or failure of conservative treatment (behavior modification, high-fiber diet, and topical hydrocortisone cream or suppositories).
1 Active Policy
A53006 — Billing and Coding: Hemorrhoid Artery Ligation
Related Codes
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