CPT 46607
Unable to determine from available CMS sources
46607 · PFS Q2 2015 · Historical
No national PFS rate in Q2 2015
Status I is not separately payable under the PFS.
Not at a published national rate. CPT 46607 carries status I (not valid) in the Q2 2015 release. Medicare uses a different code to report and pay for this service. Treat the blank amount as unpriced, not as $0.
PFS status evidence
Inspect PFS status evidence
- Code
- 46607
- Release
- Q2 2015, revision 1
- Result
- Unable to determine from available CMS sources
Citations
-
Establishes the PFS status (I) and the resulting pathway for this code: unable to determine from available cms sources.
Physician relative value file (PPRRVU)Q2 2015 · revision 1
Latest revision of this release
Release period: April 1 – June 30, 2015
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
Record details
PPRRVU15_V0213_Current.csv in rvu15b.zip (row 8,946)- hcpcs (col 1)
- 46607
- modifier (col 2)
- blank
- status_code (col 4)
- I
SHA-256: 61c24302bb17747bddd4aa44ef136d9628930f35dd595e299d9a5370bd394705
Why is there no national PFS amount for 46607?
Its status indicator is I (not valid). Medicare uses a different code to report and pay for this service. Status I is not separately payable under the PFS.
Payment considerations Copy link
Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.
Other payment indicators (8)
Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.
Why a 46607 line may not pay separately Copy link
CMS publishes no separately payable amount for 46607 in this release, so reconciling the line means establishing which status governed the date of service rather than chasing a fee-schedule difference.
What to reconcile
- Confirm the status that governed the date of service before working this line as a short payment—CMS publishes no separately payable fee-schedule amount for it in this release.
- Check the visit date: this code carries no follow-up window, so a related visit the day after the procedure is separately payable and should not have bundled.
- Check the other endoscopies on the claim: payment for this family is built from its base procedure, so a second scope from the same family will not pay its own full amount.
- Expect an assistant-at-surgery denial here rather than appealing it—a -80 or -AS line on this procedure is never separately payable.
- Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.
Nearby payment lines
National Q2 2015 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.
No comparison lines are present in this release.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Medicare Claims Processing Manual (Pub. 100-04); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.
Global period: what 46607's fee already covers Copy link
The fee covers pre-operative and post-operative work on the day of the procedure only—there is no follow-up window afterward. A visit the next day is separately payable.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What 46607's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 0 | No bilateral adjustment. The 150% bilateral payment adjustment does not apply to this procedure. |
| Assistant at surgery | 1 | Never separately payable. An assistant at surgery may never be separately paid for this procedure—a statutory restriction. |
| Co-surgeons | 0 | Not permitted. Medicare does not recognize co-surgeons (modifier 62) for this procedure. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 3 | Special endoscopic rules apply. This procedure is part of an endoscopic family; payment is based on the endoscopic base procedure rather than the standard multiple-procedure reduction. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
Can you bill it with another code? Copy link
Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 46607.
Common payment questions Copy link
Why would a Medicare claim for 46607 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is I (not valid)—Medicare uses a different code to report and pay for this service. See status indicators
- Bilateral surgery: no bilateral adjustment. See billing policy
- Assistant at surgery: never separately payable. See billing policy
- Co-surgeons: not permitted. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: special endoscopic rules apply. See billing policy
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
Rate history by release Copy link
National non-facility amount for 46607 across quarterly releases. +18.1% increase since Q1 2016 · high $230.80 in Q1 2026
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q4 2026 takes effect Oct 1, 2026 | A | $230.80 (0.0% no change ) | $113.23 (0.0% no change ) |
| Q3 2026 Jul 1, 2026 – Sep 30, 2026 | A | $230.80 (0.0% no change ) | $113.23 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | A | $230.80 (0.0% no change ) | $113.23 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | A | $230.80 (+16.0% increase ) | $113.23 (-5.6% decrease ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | A | $198.93 (0.0% no change ) | $120.01 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | A | $198.93 (0.0% no change ) | $120.01 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | A | $198.93 (0.0% no change ) | $120.01 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | A | $198.93 (-4.1% decrease ) | $120.01 (-3.1% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | A | $207.38 (0.0% no change ) | $123.83 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | A | $207.38 (0.0% no change ) | $123.83 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | A | $207.38 (0.0% no change ) | $123.83 (0.0% no change ) |
| Q1 2024 Mar 9, 2024 – Mar 31, 2024 | A | $207.38 (+1.7% increase ) | $123.83 (+1.7% increase ) |
| Q1 2024 Jan 1, 2024 – Mar 8, 2024 | A | $204.00 (-2.9% decrease ) | $121.81 (-2.3% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | A | $210.10 (0.0% no change ) | $124.70 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | A | $210.10 (0.0% no change ) | $124.70 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | A | $210.10 (0.0% no change ) | $124.70 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | A | $210.10 (-4.5% decrease ) | $124.70 (-3.7% decrease ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | A | $220.10 (0.0% no change ) | $129.43 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | A | $220.10 (0.0% no change ) | $129.43 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | A | $220.10 (0.0% no change ) | $129.43 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | A | $220.10 (+0.8% increase ) | $129.43 (-0.8% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | A | $218.43 (0.0% no change ) | $130.50 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | A | $218.43 (0.0% no change ) | $130.50 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | A | $218.43 (0.0% no change ) | $130.50 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | A | $218.43 (+5.3% increase ) | $130.50 (-0.9% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | A | $207.52 (0.0% no change ) | $131.73 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | A | $207.52 (0.0% no change ) | $131.73 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | A | $207.52 (0.0% no change ) | $131.73 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | A | $207.52 (+3.0% increase ) | $131.73 (+0.4% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | A | $201.46 (0.0% no change ) | $131.18 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | A | $201.46 (0.0% no change ) | $131.18 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | A | $201.46 (0.0% no change ) | $131.18 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | A | $201.46 (+2.1% increase ) | $131.18 (-0.7% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | A | $197.28 (0.0% no change ) | $132.12 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | A | $197.28 (0.0% no change ) | $132.12 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | A | $197.28 (0.0% no change ) | $132.12 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | A | $197.28 (+0.1% increase ) | $132.12 (0.0% no change ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | A | $197.03 (0.0% no change ) | $132.07 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | A | $197.03 (0.0% no change ) | $132.07 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | A | $197.03 (0.0% no change ) | $132.07 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | A | $197.03 (+0.8% increase ) | $132.07 (+1.3% increase ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | A | $195.49 (0.0% no change ) | $130.33 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | A | $195.49 (0.0% no change ) | $130.33 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | A | $195.49 (0.0% no change ) | $130.33 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | A | $195.49 | $130.33 |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | I | — | — |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | I | — | — |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | I | — | — |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | I | — | — |
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
The 46607 rate last moved in Q1 2026. See its rate history.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
How often 46607 is billed Copy link
Across Original Medicare in CY2024, 46607 ranked #3,521 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars.
2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q2 2015 fee schedule above.
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Source & method
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This page uses CMS's Medicare Physician Fee Schedule Q2 2015 release (effective April 2015). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This citation identifies the source release, so its evidence remains reproducible after a newer release lands.
CPT 46607 National PFS baseline: No national PFS rate (Q2 2015; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/46607/2015/B