Does 46261 require prior authorization?

No, 46261 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 46261?

Medicare facility rate: $515.38. Non-facility rate: $515.38. Work RVU: 7.57.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

7.57

Facility

$515.38

Non-Facility

$515.38

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.

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).

A53006 — Billing and Coding: Hemorrhoid Artery Ligation

Ask Verity about documentation requirements, denial risks, or coverage in your state.