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CPT 46220: Excision of External Anal Papilla (Skin Tag)

CPT code 46220 identifies the excision of an external anal papilla or skin tag, a minor anorectal surgical procedure frequently performed to relieve symptoms or to aid management of adjacent fissures or fistulas. Nationally, this code matters because it captures a common outpatient surgical intervention in colorectal and general surgery practices and informs payment, quality measurement, and utilization monitoring for anorectal care.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and the payer landscape covered in this analysis. The publication reviews national benchmarks for utilization and reimbursement patterns where available, highlights relevant policy considerations affecting outpatient minor surgical procedures, and situates 46220 within common clinical workflows for anal fissure and fistula management.

This summary equips clinicians, coding professionals, and policy analysts with concise guidance on what CPT code 46220 represents, why it is billed, and what to expect when evaluating claims and coverage decisions for minor anorectal excisions. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 46220 describes the surgical removal of an external anal papilla or skin tag located at the external margin of the anus. The procedure addresses small, external benign lesions that are often associated with the edge of an anal fissure or fistula and may be excised for symptomatic relief or to facilitate treatment of the primary anorectal condition.

Service Type: Minor surgical excision of external anorectal skin lesion

Typical Site of Service: Ambulatory surgical center or outpatient clinic/procedural room, often performed under local anesthesia. Data not available in the input.

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CPT 46220: Excision of External Anal Papilla (Skin Tag)

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Get alerted when payer policies referencing 46220 are released or updated.

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Billing Code Overview

Service Type: Minor surgical excision of external anorectal skin lesion

Typical Site of Service: Ambulatory surgical center or outpatient clinic/procedural room, often performed under local anesthesia. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents to an outpatient colorectal clinic with a several-week history of pain and occasional bleeding at the anal verge. On examination the clinician identifies an external anal papilla (skin tag) adjacent to the external edge of a chronic anal fissure. Conservative measures have been attempted but the lesion causes hygiene difficulty and persistent discomfort. The patient is scheduled for a minor office-based procedure under local anesthesia. The clinical workflow includes pre-procedure consent, focused anorectal exam and photography as indicated, local infiltration anesthesia (for example, 1% lidocaine), excision of the external papilla with scissors or electrocautery, hemostasis, specimen handling if indicated, wound dressing, and post-procedure instructions with follow-up for wound check and pathology results if the specimen is sent.

Coding Specifications

Modifier	Description	When to Use
`11`	Unusual procedural service (separate identifiable E/M)	Use when a significant, separately identifiable E/M visit is reported on the same day as the procedure.
`22`	Increased procedural services	Use when the work required to remove the lesion is substantially greater than typical for the code.
`23`	Unusual anesthesia — without documented anesthesia	Use when a procedure usually requiring anesthesia is performed without typical anesthesia for medical reasons.
`26`	Professional component	Use when reporting only the professional component of a service that has separate technical and professional components (rare for this CPT).
`50`	Bilateral procedure	Use if identical external lesions are removed from both sides and payer requires bilateral modifier.
`51`	Multiple procedures	Use when multiple distinct procedures are performed during the same session in addition to `46220`.
`52`	Reduced services	Use when the service performed is less than described by the code.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use when another procedure performed at the same encounter is anatomically distinct and not usually bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`76`	Repeat procedure by same physician	Use when the procedure is repeated subsequent to an earlier attempt on the same date by the same physician.
`77`	Repeat procedure by another physician	Use when the procedure is repeated by a different physician on the same date.
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure for related procedure during the postoperative period	Use for return to the procedure room for a complication related to the initial procedure.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Colon and Rectal Surgery	Specialists who commonly perform anorectal excisions.
`207L00000X`	General Surgery	General surgeons who manage anorectal pathology.
`208D00000X`	Family Medicine	Primary care clinicians who may perform minor office-based excisions.
`2086S0125X`	Gastroenterology	Gastroenterologists who perform anorectal procedures in some settings.
`208000000X`	General Practice	Physicians in outpatient settings who may remove external anal lesions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.2`	Anal fissure, unspecified	External papillae often form at the edge of chronic anal fissures; excision may be performed for symptomatic relief.
`K60.3`	Anal fistula	External tags commonly associate with fistula-in-ano; identification may prompt concurrent fistula management.
`K62.5`	Hemorrhoids, external	External skin tags may represent remnants of healed hemorrhoids; coexisting hemorrhoidal disease may be addressed concurrently.
`L91.8`	Other hypertrophic disorders of skin	Hypertrophic skin changes at the anal verge that are symptomatic and may require excision.
`R19.4`	Change in bowel habit (include for evaluation context)	Symptom code that may be present in the workup of anorectal disease prompting procedural intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46221`	Excision of anal skin tag(s); more than one and/or complicated	Performed when multiple or more complex external tags require broader excision than `46220`.
`46255`	Fistulectomy, simple or with fistulotomy, with or without seton	Performed when an underlying fistula is identified and requires definitive surgical management beyond tag excision.
`46900`	Hemorrhoidectomy, by various techniques; internal and external (separate procedures)	Performed when symptomatic hemorrhoidal disease coexists and requires surgical treatment in addition to tag removal.
`99212`	Office or other outpatient visit for evaluation and management, low complexity	Represents typical pre-procedure or post-procedure E/M services bundled or reported separately with modifier `11` when significant and separately identifiable.
`88305`	Level IV pathology examination of tissue	Reported when excised tissue is submitted to pathology for microscopic examination.

CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy

CPT-46221-HEMORRHOID-RUBBER-BAND-LIGATION

CPT 46221: Rubber Band Ligation of Internal Hemorrhoid

CPT-46230-ANAL-SKIN-TAG-EXCISION-MULTIPLE-EXTERNAL-PAPILLAE

CPT 46230: Excision of Multiple External Anal Papillae (Skin Tags)

CPT-46250-EXCISION-TWO-OR-MORE-EXTERNAL-HEMORRHOIDS

CPT 46250: Excision of Two or More External Hemorrhoids

CPT-46255-EXCISION-INTERNAL-EXTERNAL-HEMORRHOID

CPT 46255: Excision of Single Internal and External Hemorrhoid

CPT-46257-HEMORRHOID-EXCISION-WITH-ANAL-FISSURE-REMOVAL

CPT 46257: Excision of Hemorrhoid Group with Anal Fissure Removal

CPT-46258-HEMORRHOID-FISTULA-FISSURE-EXCISION

CPT 46258: Excision of Hemorrhoid Group with Fistula and Fissure

CPT-46260-HEMORRHOIDECTOMY-TWO-OR-MORE-HEMORRHOIDS

CPT 46260: Excision of Two or More Internal and External Hemorrhoids

CPT-46261-HEMORRHOIDECTOMY-MULTIPLE-HEMORRHOIDS-WITH-FISSURE-REMOVAL

CPT 46261: Excision of Multiple Hemorrhoids with Fissure Removal

CPT-46262-HEMORRHOID-EXCISION-WITH-FISTULA-FISSURE-REMOVAL

CPT 46262: Excision of Multiple Hemorrhoids; Possible Fistula/Fissure Removal

Showing 1–10 of 16

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Unusual procedural service (separate identifiable E/M)	Use when a significant, separately identifiable E/M visit is reported on the same day as the procedure.
`22`	Increased procedural services	Use when the work required to remove the lesion is substantially greater than typical for the code.
`23`	Unusual anesthesia — without documented anesthesia	Use when a procedure usually requiring anesthesia is performed without typical anesthesia for medical reasons.
`26`	Professional component	Use when reporting only the professional component of a service that has separate technical and professional components (rare for this CPT).
`50`	Bilateral procedure	Use if identical external lesions are removed from both sides and payer requires bilateral modifier.
`51`	Multiple procedures	Use when multiple distinct procedures are performed during the same session in addition to `46220`.
`52`	Reduced services	Use when the service performed is less than described by the code.
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use when another procedure performed at the same encounter is anatomically distinct and not usually bundled.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`76`	Repeat procedure by same physician	Use when the procedure is repeated subsequent to an earlier attempt on the same date by the same physician.
`77`	Repeat procedure by another physician	Use when the procedure is repeated by a different physician on the same date.
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure for related procedure during the postoperative period	Use for return to the procedure room for a complication related to the initial procedure.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Colon and Rectal Surgery	Specialists who commonly perform anorectal excisions.
`207L00000X`	General Surgery	General surgeons who manage anorectal pathology.
`208D00000X`	Family Medicine	Primary care clinicians who may perform minor office-based excisions.
`2086S0125X`	Gastroenterology	Gastroenterologists who perform anorectal procedures in some settings.
`208000000X`	General Practice	Physicians in outpatient settings who may remove external anal lesions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K60.2`	Anal fissure, unspecified	External papillae often form at the edge of chronic anal fissures; excision may be performed for symptomatic relief.
`K60.3`	Anal fistula	External tags commonly associate with fistula-in-ano; identification may prompt concurrent fistula management.
`K62.5`	Hemorrhoids, external	External skin tags may represent remnants of healed hemorrhoids; coexisting hemorrhoidal disease may be addressed concurrently.
`L91.8`	Other hypertrophic disorders of skin	Hypertrophic skin changes at the anal verge that are symptomatic and may require excision.
`R19.4`	Change in bowel habit (include for evaluation context)	Symptom code that may be present in the workup of anorectal disease prompting procedural intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`46221`	Excision of anal skin tag(s); more than one and/or complicated	Performed when multiple or more complex external tags require broader excision than `46220`.
`46255`	Fistulectomy, simple or with fistulotomy, with or without seton	Performed when an underlying fistula is identified and requires definitive surgical management beyond tag excision.
`46900`	Hemorrhoidectomy, by various techniques; internal and external (separate procedures)	Performed when symptomatic hemorrhoidal disease coexists and requires surgical treatment in addition to tag removal.
`99212`	Office or other outpatient visit for evaluation and management, low complexity	Represents typical pre-procedure or post-procedure E/M services bundled or reported separately with modifier `11` when significant and separately identifiable.
`88305`	Level IV pathology examination of tissue	Reported when excised tissue is submitted to pathology for microscopic examination.

CPT 46200: Excision of Anal Fissure with Possible Sphincterotomy

CPT-46221-HEMORRHOID-RUBBER-BAND-LIGATION

CPT 46221: Rubber Band Ligation of Internal Hemorrhoid

CPT-46230-ANAL-SKIN-TAG-EXCISION-MULTIPLE-EXTERNAL-PAPILLAE

CPT 46230: Excision of Multiple External Anal Papillae (Skin Tags)

CPT-46250-EXCISION-TWO-OR-MORE-EXTERNAL-HEMORRHOIDS

CPT 46250: Excision of Two or More External Hemorrhoids

CPT-46255-EXCISION-INTERNAL-EXTERNAL-HEMORRHOID

CPT 46255: Excision of Single Internal and External Hemorrhoid

CPT-46257-HEMORRHOID-EXCISION-WITH-ANAL-FISSURE-REMOVAL

CPT 46257: Excision of Hemorrhoid Group with Anal Fissure Removal

CPT-46258-HEMORRHOID-FISTULA-FISSURE-EXCISION

CPT 46258: Excision of Hemorrhoid Group with Fistula and Fissure

CPT-46260-HEMORRHOIDECTOMY-TWO-OR-MORE-HEMORRHOIDS

CPT 46260: Excision of Two or More Internal and External Hemorrhoids

CPT-46261-HEMORRHOIDECTOMY-MULTIPLE-HEMORRHOIDS-WITH-FISSURE-REMOVAL

CPT 46261: Excision of Multiple Hemorrhoids with Fissure Removal

CPT-46262-HEMORRHOID-EXCISION-WITH-FISTULA-FISSURE-REMOVAL

CPT 46262: Excision of Multiple Hemorrhoids; Possible Fistula/Fissure Removal

Showing 1–10 of 16

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 46220: Excision of External Anal Papilla (Skin Tag)

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Billing Code Overview

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CPT 46220: Excision of External Anal Papilla (Skin Tag)

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 46220: Excision of External Anal Papilla (Skin Tag)

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Billing Code Overview

CPT 46220: Excision of External Anal Papilla (Skin Tag)

Sign up for cpt 46220 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical procedure does CPT 46220 represent?

Which modifiers are commonly used with 46220 and when should they be considered?

What related CPT codes might be billed instead of or alongside 46220?

Which ICD-10 diagnosis codes are commonly associated with claims for 46220?

Where is 46220 usually performed, which specialties perform it, and which payers are referenced?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical procedure does CPT 46220 represent?

Which modifiers are commonly used with 46220 and when should they be considered?

What related CPT codes might be billed instead of or alongside 46220?

Which ICD-10 diagnosis codes are commonly associated with claims for 46220?

Where is 46220 usually performed, which specialties perform it, and which payers are referenced?

References