Does 46948 require prior authorization?

No, 46948 does not require prior authorization (low confidence). No active coverage policies found for this code.

What is the Medicare reimbursement rate for 46948?

Medicare facility rate: $445.57. Non-facility rate: $445.57. Work RVU: 5.43.

HCPCS/CPT

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Work RVU

5.43

Facility

$445.57

Non-Facility

$445.57

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

ANTHEM-SURG.00141 — SURG.00141 Doppler-Guided Transanal Hemorrhoidal Dearterialization

REGENCE-SUR219 — Transanal Hemorrhoidal Dearterialization

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