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    v1.0.30
    OpenPayerBilling CodesExcision Procedures on the AnusCPT cpt-46257-hemorrhoid-excision-with-anal-fissure-removal
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    CPT 46257: Excision of Hemorrhoids with Fissure Removal

    Medicare pays $427 on average nationally for this procedure.

    CPT code 46257 describes a surgical procedure in which the provider excises a single internal and external hemorrhoid group and concurrently removes an open sore of the lower rectum known as a fissure; service type: anorectal surgery; typical site of service: operating room or ambulatory surgery center for minor colorectal procedures.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old adult presents to an outpatient surgical clinic with persistent symptomatic hemorrhoidal disease and a chronic posterior anal fissure. Symptoms include bright red rectal bleeding with bowel movements, perianal pain, and discomfort refractory to conservative measures (fiber, topical agents, stool softeners). Examination under anesthesia confirms a single combined internal and external hemorrhoid group and a chronic fissure of the lower rectum. The surgeon schedules a single operative session to excise the symptomatic internal and external hemorrhoidal complex and to perform fissure excision/repair. The procedure is typically performed in an ambulatory surgery center or hospital outpatient department under regional or general anesthesia. Intraoperative workflow includes preoperative consent and time-out, anesthesia induction, anoscopic examination, excision of the hemorrhoidal tissue (internal and external components) and debridement/excision of the fissure, hemostasis, and local wound care. Postoperative recovery includes analgesia, instructions for stool softening, wound care, and a short-term follow-up visit to assess wound healing and symptom resolution.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    46040Excision of perianal fistula; simplePerformed when a fistula is present alongside hemorrhoids; may be done in separate or combined operative session
    46221Excision of internal hemorrhoids, single column or cluster (e.g., rubber band ligation not included)Alternative procedure for internal hemorrhoids when less extensive excision is required
    46500Fissurectomy, with or without sphincterotomyRelated procedure for anal fissure management; may be used if fissure requires more extensive excision or sphincterotomy
    46922Excision, other - anus (simple)Codes for other simple anal excisions that might be performed in conjunction or as an alternative depending on lesion location
    45380Flexible sigmoidoscopy, diagnostic; with biopsyPreoperative or diagnostic endoscopic evaluation of distal colorectum when indicated before operative management
    99024Postoperative follow-up visit global surgery package (professional service)Used for routine postoperative follow-up visits within the global period as applicable

    Related Modifiers

    9 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207X00000X
    208800000X
    207L00000X
    163W00000X
    363L00000X
    2278P3800X
    163WN0002X
    261QS0132X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding
    K57.32Diverticulitis of large intestine without perforation or abscess without bleeding
    K57.50Diverticulosis of both small and large intestine without perforation or abscess without bleeding
    K57.52Diverticulitis of both small and large intestine without perforation or abscess without bleeding
    K59.9Functional intestinal disorder, unspecified
    K60.0Acute anal fissure
    K60.1Chronic anal fissure
    K60.2Anal fissure, unspecified
    K62.0Anal polyp
    K62.4Stenosis of anus and rectum

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-46200-ANAL-FISSURE-EXCISION-SPHINCTEROTOMY

    CPT 46200: Anal Fissure Excision with Possible Sphincterotomy

    CPT-46220-EXCISION-EXTERNAL-ANAL-PAPILLA-SKIN-TAG

    CPT 46220: Excision of External Anal Papilla or Skin Tag

    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 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-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 Anal Fissure

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

    CPT 46262: Excision of Multiple Hemorrhoids with Fistula

    Showing 1–10 of 16

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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