How much does Medicare pay for CPT 46607?

Medicare allowed an average of $147.72 per service and paid $107.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $980.25, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 46607?

Biopsy of anus with magnification and chemical agent enhancement using an endoscope. It was billed 1,392 times to 1,236 Medicare beneficiaries by 48 providers in 2024.

Does 46607 pay differently in an office than a hospital?

Yes. The allowed amount averaged $176.04 in an office setting and $120.12 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 46607 most?

Nurse Practitioner, with 366 services from 10 clinicians. Next are Infectious Disease, Colorectal Surgery (Proctology), Gastroenterology.

CPT 46607

Biopsy of anus with magnification and chemical agent enhancement using an endoscope

$147.72Medicare-allowed amount per service, averaged across 1,392 services

Providers submitted

$980.25

Asking price, not received

Medicare allowed

$147.72

The fee schedule figure

Medicare paid

$107.35

Balance is patient coinsurance

Providers submitted an average of $980.25 for this code and Medicare allowed $147.72 — 6.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $107.35 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $176.04
Hospital / facility: $120.12

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 687 services were billed in an office setting and 705 in a facility.

Services: 1,392
Beneficiaries: 1,236
Providers billing it: 48
Total allowed: $205,626

What Medicare pays for CPT 46607

Across 1,392 services billed by 48 providers to 1,236 beneficiaries, Medicare allowed an average of $147.72 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 46607

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	366	336	$116.07	10
Infectious Disease	346	304	$134.25	10
Colorectal Surgery (Proctology)	187	165	$182.37	10
Gastroenterology	98	87	$218.56	3
Physician Assistant	77	69	$115.58	4
Preventive Medicine	77	67	$126.96	1
Internal Medicine	68	65	$220.31	3
General Surgery	49	34	$167.98	2
Obstetrics & Gynecology	48	43	$113.86	2
Hematology-Oncology	33	29	$136.57	1
Family Practice	22	19	$222.34	1
Emergency Medicine	21	18	$210.66	1

46607 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	493	$127.26	$81.25	11
New York	144	$138.78	$89.62	6
Massachusetts	119	$178.87	$119.15	5
Pennsylvania	110	$126.61	$80.23	4
Maryland	105	$219.25	$155.50	3
Colorado	84	$108.72	$78.49	3
Washington	68	$130.58	$75.02	2
Oregon	52	$102.35	$76.16	2
Texas	44	$180.49	$124.63	2
Florida	34	$201.17	$137.16	2
District of Columbia	31	$232.52	$134.30	2
Illinois	30	$217.67	$145.97	1
Minnesota	27	$144.47	$111.77	2
Arizona	19	$126.89	$97.08	1
Georgia	16	$205.87	$146.30	1
Nevada	16	$200.98	$161.43	1

Related codes

46600Diagnostic exam of anus$108.73
46601Diagnostic exam of anus$110.44

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.