Office-based treatment of grade II-III internal hemorrhoids

Internal hemorrhoids are graded I-IV by degree of prolapse; grade II-III disease is the band where conservative management has failed but full surgical hemorrhoidectomy is not yet required, and where an in-office procedural device competes directly against rubber band ligation, infrared coagulation, and sclerotherapy — all cheap, established, already-owned instruments. State the thinness up front: this pass ran a broad literature sweep and a real CMS payment-file retrieval (a genuine first for this repo's reimbursement work — see §6) but did not touch epidemiology beyond one review-article prevalence figure, did not search user groups/incentives at all, and could not retrieve full text of either ASCRS clinical practice guideline (paywalled). A later reader should treat sections 2, 3, and the grade-specific epidemiology row in §1 as effectively unwritten.

This file carries no confidence tags. Every line below is context with a source attached. To affect a score, a line must be copied into a candidate's ## Claims as unverified and pass the Verifier or the Corroborator. See README.md in this directory.

CPT descriptors are AMA-licensed and are never reproduced here, in whole or in short-descriptor form — §6 scopes strictly to code numbers and CMS administrative-file fields (RVUs, global-day indicator, conversion factor), never to the codes' descriptive text.

1. Condition & epidemiology

as_of: 2026-08-27 · sources searched: connectors literature ("prevalence hemorrhoids United States" — too broad to be useful, and "hemorrhoids grade distribution" was not separately run), literature-detail on the two review articles below · not searched: incidence, demographic/racial/regional concentration, trend direction, and — the gap that matters most for this domain — what share of symptomatic patients present at grade II-III specifically rather than grade I or IV

Verbatim:

"Hemorrhoidal disease, pathology of the tissue lining of the anal canal, affects approximately 10 million individuals in the US." — [1]

Read this narrowly: [1] is a JAMA narrative review (tertiary source, no methods section, no stated primary source for the 10-million figure itself), not a US surveillance study. It is the only US population-level prevalence figure this pass located, and it is not grade-stratified.

Gaps: grade-specific prevalence (the number that would size this candidate's actual addressable population) is not found, not merely not searched hard enough — one broad query returned 3,749 matches dominated by unrelated colorectal-surgery topics and was not narrowed further this pass. Incidence, demographic concentration, and trend direction were not searched at all.

2. Care pathway & clinical setting

as_of: 2026-08-27 · sources searched: the two guideline-adjacent abstracts in §4; one literature query for "hemorrhoids primary care referral colorectal surgery office procedure" (0 results) · not searched: anything about primary care as an entry point, throughput, staffing, or equipment already in the room

Two societies claim overlapping ownership of this pathway, and this dossier does not resolve which one sees a given patient first. AGA's own guideline states outright: "The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist" — [2]. ASCRS separately maintains its own hemorrhoid guideline (2018 [3], updated 2024 [4]) as the colorectal-surgery society's counterpart document. Neither source in this pass states what fraction of grade II-III patients enter through primary care, gastroenterology, or colorectal surgery directly — that split is not found.

Verbatim:

"BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis." — [2]

Gaps: the entire primary-care-to-specialist referral question; staffing and throughput in the office setting; whether the procedure is typically done at initial consultation or a follow-up visit.

3. User groups & incentives

as_of: 2026-08-27

Not searched. No source has been queried for this section. Recorded so the shape is visible: prescriber/decider (whichever specialty sees the patient — see §2's unresolved split), operator (the same physician, since this is a same-visit office procedure, not a device handed to ancillary staff), purchaser (the practice), payer (Medicare and commercial, with the site-of-service economics turning on the non-facility payment — see §6), and patient are at minimum five parties. None of their incentives are evidenced here.

Gaps: the entire section.

4. Standard of care & clinical evidence

as_of: 2026-08-27 · sources searched: connectors literature ("ASCRS clinical practice guideline hemorrhoids", "clinical practice guideline management of hemorrhoids Davis", "rubber band ligation internal hemorrhoids recurrence", "infrared coagulation hemorrhoids recurrence"), literature-detail on 10 PMIDs, one attempted WebFetch of the ASCRS 2018 guideline's paywalled full text (HTTP 402) and one of its free-toolkit PDF mirror (retrieved 947.7KB of binary PDF content that this pass's tools could not render to text — pdftoppm/ poppler-utils is not installed in this environment) · not searched: CLSI/KDIGO-equivalent formal evidence grading tables, the ASCRS document's own cited evidence base

The ASCRS guideline's existence is established; its content is not retrievable this pass, and that is a stated access limitation, not a finding about its content. Two versions are registered in PubMed — the original 2018 guideline [3] and a 2024 update [4] — and neither PubMed record carries an abstract (common for this journal's practice guidelines). The full-text host (journals.lww.com) returned HTTP 402 Payment Required to a direct fetch, and a free-toolkit PDF mirror was retrieved as bytes but could not be rendered to text by the tools available this pass. A future pass should retry the PDF render (poppler-utils would need to be available) before concluding the guideline is unreachable.

In its place, the AGA's 2026 Clinical Practice Update [2] — a comparable US society-level guideline covering the identical treatment ladder — was fully retrievable with a structured, quotable abstract, and is used below as the guideline-quality source for this section.

Verbatim:

"Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids." — [2]

"Consultation with a surgeon should be offered to patients with grade 3 internal hemorrhoids who fail banding procedures or have associated external hemorrhoids... Grade 4 internal hemorrhoids require surgical hemorrhoidectomy." — [2]

"Open and closed haemorrhoidectomy, and stapled haemorrhoidopexy were associated with worse pain, and more postprocedural bleeding, urinary retention, and bowel incontinence, but had the lowest rates of symptom recurrence." — [5]

"Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%)." — [7]

Read [5] and [7] together, carefully, because they frame this candidate's entire regulatory-strategy question. The standing guideline advice [2] treats office banding/IRC as adequate first-line therapy through grade III. The best-controlled single RCT that isolated grade III specifically [7] found RBL's own durability at that grade substantially worse than surgery, on a primary endpoint the trial was explicitly designed (if underpowered) to test. Neither finding contradicts the other — a treatment can be guideline-endorsed as first-line and still show a real recurrence gap versus surgery at the higher grade — but a candidate proposing to out-perform RBL specifically at grade III should read [7] as the evidence bar its own mechanism-and-clinical-risk claim needs to clear, not [2]'s general endorsement.

Gaps: no formal evidence-graded ASCRS position was retrieved (see access-limitation note above); no US-specific comparative trial was located — [7] is Dutch, and the balance of the comparative literature found this pass (§5) is Chinese; no data located on how often grade III patients are in practice treated in-office versus referred directly to surgery.

5. Reference products — and why people stop using them

as_of: 2026-08-27 · sources searched: connectors literature + literature-detail (14 PMIDs read at abstract depth across four searches), connectors clearances/510k/ clearance-summary/recalls/classification (device- and firm-scoped), connectors trials/trial-detail · not searched: MAUDE (no connector in this repo), any US-specific RBL/IRC/sclerotherapy cohort (everything comparative located this pass is Dutch or Chinese)

This is the load-bearing section for this domain, and the direct comparator class is well populated: three non-surgical office modalities the incumbent literature treats as roughly interchangeable first-line options, plus a cleared RF/electrosurgical device landscape more extensive than a device-name search alone would surface.

Rubber band ligation (RBL) — the entrenched office standard

• What it is: an elastic band placed around the base of the hemorrhoidal column via anoscopy, to strangulate and fix the prolapsing tissue.
• Cleared devices: RBL delivery systems are a separately regulated, 510(k)-exempt class — 21 CFR 876.4400, product code FHN, "Ligator, Hemorrhoidal" [25] — meaning a follower device faces no premarket-notification barrier at all. A named example: K131282, Nexus Hemorrhoid Ligator (Inx Medical), cleared 2013-07-11 [21].
• Price / what it realizes per unit: not established this pass; scoped out of reach by the CPT-descriptor licence restriction (see §6) for the professional-fee side, and no device-price source was queried.
• Evidence behind it: see §4.
• Abandonment record — why people stop:

• Verbatim, for anything load-bearing:

"Recurrence rate was worse in the rubber band ligation group (47.5% vs 6.1%), with an absolute risk difference of 41% (95% CI, 24%-59%)." — [7]

"Massive, delayed bleeding (DB) is the most common major complication of Rubber Band Ligation (RBL) for internal hemorrhoids caused by premature band slippage." — [10]

Read the recurrence numbers in this table as four different questions, not four estimates of the same fact — this dossier does not reconcile them, and neither should a later reader without going back to methods. [7]'s 47.5% is grade-III-only, 12-month, RCT-controlled, non-US. [8]'s 9.7% pools grades I-III, uses a >3-month recurrence definition, and is a single-centre retrospective series. [9]'s 32.8%-vs-14.6% split is the one result here that isolates grade as the variable within a single cohort and design, and it is the most directly relevant single number to this candidate's own scope note (durability specifically "at grade III"): recurrence roughly doubles or more from grade I-II to grade III in the same series. No US-population recurrence figure for RBL at any grade was located.

Infrared coagulation (IRC)

• What it is: infrared heat applied to hemorrhoidal tissue to induce coagulation and fibrosis, delivered in-office via a handheld probe.
• Evidence behind it: [1], [2], [5], [6] above — no IRC-specific pivotal trial or device 510(k) summary was individually retrieved this pass.
• Abandonment record — why people stop:

• Verbatim:

"Infrared coagulation uses heat to coagulate hemorrhoidal tissue, yielding 70% to 80% success in reducing bleeding and prolapse." — [1]

Gaps: no grade-III-isolated IRC recurrence figure comparable to [7]'s RBL number was located; no cleared IRC device was individually traced to a K-number this pass (a device-name search for "infrared coagulat*" was not run).

Sclerotherapy (injection ± foam)

• What it is: a sclerosant (historically phenol-based; polidocanol foam in more recent trials) injected into the submucosa to induce fibrosis.
• Evidence behind it: [1], [8], [11].
• Abandonment record — why people stop:

• Verbatim:

"Sclerotherapy, which induces fibrosis with a sclerosant injection, is efficacious in the short term (weeks to months) among 70% to 85% of patients, but long-term remission occurs in only one-third of patients." — [1]

Read this the same way as the RBL table: [1]'s "one-third long-term remission" figure is a tertiary-source claim with no primary study cited in the retrieved abstract text; [8] and [11] are the two primary comparative figures located, and both used sclerotherapy in combination with or against RBL rather than as monotherapy grade III data in isolation. No sclerotherapy-alone grade-III-isolated recurrence figure comparable to [7]'s RBL number was found.

Existing RF / electrosurgical office hemorrhoid devices — the direct predicate class

This is the section most relevant to this candidate specifically, and it is more extensive than a device-name search for "radiofrequency" or "hemorrhoid" alone would surface — the cleared devices below carry internal-hemorrhoid or anal-canal indications while several carry neither word in FDA's device-name field.

• HET Bipolar Electrocautery Forceps/Monitor family (product code GEI, 21 CFR 878.4400, review panel SU [25][26]) — a four-clearance history: K110143 (HET Systems, LLC, 2011, hemorrhoids not named), K121085 (HET Systems, LLC, 2012-11-20) [12], K140422 (HET Systems, LLC, 2014-06-05) [13], and K200146 (Covidien, LLC, 2020-05-07) [14] — the most recent holder is a large strategic (Covidien/Medtronic), not a dormant small-firm device.
  • Cleared indication, verbatim (K121085): "The HET Bipolar Electrocautery Forceps and Monitor are intended to be used for grasping, manipulating and coagulating soft tissue during general surgery. The HET Bipolar Electrocautery Forceps and Monitor may be used for the treatment of symptomatic Grade I and Grade II internal hemorrhoids." — [12]
  • The regulatory ceiling every candidate in this domain needs to read: every located IFU for this device family stops at grade II. No abandonment/adoption evidence was located either way for this specific product line — no recall, no MAUDE (unreachable), no market-share figure.
• Ultroid Hemorrhoid Management System (product code KNS, 21 CFR 876.4300, review panel GU [25][26]) — K023706 and K030315 (Ultroid, LLC, 2003) [15][16], a direct-current/thermal coagulation modality, the only device located this pass whose IFU spans the full grade I-IV range.
  • Cleared indication, verbatim (K030315): "The Ultroid Hemorrhoid Management system is intended for physician use only... It is intended for coagulative hemostatic therapy of internal hemorrhoids grades I, [I]I, I[I]I, IV." — [15]
  • Abandonment signal — a real recall, on the disposable consumable specifically. Four related FDA recall records, initiated 2016-10-19, status Terminated, covering the generator/console, the mobile/battery unit, the procedure pack, and the sterile disposable probes sold individually: "Products are not designed, qualified, manufactured, and/or managed under a state of control per internal quality system procedures... (such as 21 CFR 820 Quality System Regulation)." — [23]. This is a quality-system/process-control recall, not a stated safety or efficacy failure, but it is a genuine, sourced abandonment-adjacent event on the one cleared device in this domain whose business model (console + disposable probe) is closest to this candidate's own, and on its consumable line specifically.
• Barrx Anorectal RFA Wand (product code GEI, same 878.4400/SU as the HET family [25][26]) — K150251 (2015-07-28) and K162802 (2017-01-24), both Covidien, LLC — establishes that RF energy delivered inside the anal canal is itself cleared-device territory, but not for hemorrhoids:

"The Barrx Anorectal RFA Wand is indicated for use in the coagulation of bleeding and non-bleeding sites in the anal canal and rectum including, but not limited to, arteriovenous malformations, angiomata, angiodysplasia, radiation proctitis (RP), and anal intraepithelial neoplasia (AIN)" — [18]. Hemorrhoids are not named.

• **Companies with no anorectal indication in their entire US clearance history, checked and ruled out this pass:** F Care Systems (Belgium) / F Care Systems USA, LLC — three total US 510(k)s (K130283 "EVRF SYSTEM", K210077 "MED RF 4000", K253918 "Veineo System") — all venous or aesthetic (superficial vein reflux thermocoagulation, epilation), none anorectal. A device named "Rafaelo" or "CRA probe," referenced in some international RF-hemorrhoid literature, returns no match on an openFDA device-name search [20's family — no independent citation number, since this is a null result]. This does not establish the device is uncleared in the US under a different name; it establishes only that no US 510(k) record carries that device name.

Disposable anoscope — the delivery-vehicle position is already occupied

• SleeveLUX 24/16 Anoscope/Proctoscope, Haemoband Surgical, Ltd. — K250645, cleared 2025-10-09, product code FER, 21 CFR 876.1500 [17][25][26]. Cleared indication, verbatim: "SleeveLUX Anoscope/Proctoscope is a class 2 self-illuminating disposable instrument used to assist clinicians when treating and/or diagnose conditions in the anal canal and the lower rectum such as 1st 2nd and 3rd degree hemorrhoids." — [17]. This is a single-use anoscope already indicated through grade III hemorrhoids, cleared four months before this dossier was built, by a firm whose name signals a ligation-adjacent focus. Whether practices would choose a single-use anoscope over a reusable one is not established either way (a class-3 question — see §9).
• The anoscope class overall is active and commoditizing: three 510(k)s in five years, all product code FER — K250645 (2025) [17], K230439 (WellCare, 2023), K200021 (Applied Medical, 2021) [25 — same classification family].

Gaps: no US-population abandonment/discontinuation figure for any of these three office modalities was located (everything comparative is Dutch or Chinese); MAUDE has no connector in this repo, so device-level complaint/failure-mode data for any named device above is unsearched; no device price for RBL bands, IRC units, sclerosant, or any cleared RF console/probe was located.

6. Reimbursement landscape

as_of: 2026-08-27 · sources searched: connectors payment/coverage/procedures/hcpcs (all four, code 46930/46945/46946 — no local data/ cache present, confirmed distinct from "not found"); pfs.data.cms.gov's public metastore API, fetched directly this pass — the first successful primary-source retrieval of CMS Physician Fee Schedule RVU data in this repo · not searched: the CMS NCCI PTP quarterly edit-pair file (public, code-number-keyed, not fetched this pass); Medicare NCD/LCD text for office hemorrhoid destruction

A CMS administrative data file for the CY2026 Physician Fee Schedule was located, is directly downloadable, and was fetched this pass — pfs.data.cms.gov's public metastore lists an "Indicators for 2026" dataset (identifier 7c7df311-5315-4f38-b9ed-fd62f8bebe11, distribution URL https://pfs.data.cms.gov/sites/default/files/data/indicators2026-07-01-2026.csv). This is a government-published RVU/indicator file (columns include hcpc, rvu_work, full_nfac_total, full_fac_total, global, conv_fact), not an aggregator table, and it resolves several items this repo's candidate file for this domain (idea-008) had flagged as blocked only by a missing local cache:

Payment = total RVU (work + practice expense + malpractice, national unadjusted, GPCI not applied) × conversion factor. Two conversion factors (33.4009 and 33.5675) are both present in the same 2026 file with no distinguishing date/quarter column — this pass could not establish which billing scenario each applies to (a plausible but unconfirmed explanation is the Qualifying-APM vs non-Qualifying-APM conversion-factor split CMS has applied in recent years) and reports both rather than picking one. Locality-adjusted (GPCI-applied) local Medicare Administrative Contractor payment will differ from this national-unadjusted figure in either direction depending on locality.

This resolves one item and reframes another that this domain's existing candidate file (idea-008) had recorded. The 90-day global period claim is independently confirmed by this file's public global column (090 for all three codes) — a CMS administrative field, not AMA-licensed descriptor text, so this was checkable all along without a licensed CPT source. Separately, and worth flagging explicitly for a Verifier rather than resolved here: the non-facility figure computed from this primary CMS file (~$248-249) is the higher of the two 46930 settings, and the facility figure (~$158) is the lower one — the reverse pairing of "~$248 facility / ~$158 non-facility" that idea-008's claims section currently carries, sourced there to two commercial aggregator sites. This dossier does not resolve which pairing is correct; it records that a primary CMS source and the aggregator-sourced claim disagree on which setting gets which number, which is exactly the kind of label-inversion aggregator data is prone to.

Gaps: the CMS NCCI PTP quarterly edit-pair file (the source that would settle the CCI bundling-into-46945 claim) was not fetched this pass, though it is public and code-number-keyed, same as this section's other gaps. No NCD/LCD text was located for office hemorrhoid destruction. hcpcs, payment, coverage, and procedures connector calls all still return unconfirmed for lack of a local data/ cache — this is a missing input, not a finding, and is now a narrower gap than before this pass, since the actual source file (pfs.data.cms.gov) is not on engine/scripts/fetch_data_file.py's host allowlist (only www.cms.gov, cms.gov, data.cms.gov, and the two accessdata.fda.gov variants are allowed) — loading it into data/hcpcs_payment_rates.csv would need either a hand-attached file or an allowlist change, neither of which is this pass's call to make.

7. Technology trajectory

as_of: 2026-08-27

A counted series — clearances per year, entrants per year — cannot carry a confidence tag anywhere in this repo; the counts above are context, not a scored trend.

Gaps: no search was run for newer non-RF energy modalities (laser hemorrhoidoplasty, Doppler-guided hemorrhoidal artery ligation devices, direct-current coagulation beyond Ultroid); no search for impedance-based dosimetry or automatic-cutoff feature precedent in any cleared electrosurgical device, which is this candidate's own specific differentiator.

8. Market players & dynamics

as_of: 2026-08-27

Gaps: no funding, revenue, or installed-base data for any player above was searched; no search was run for entrants using non-RF modalities (Doppler-guided ligation device makers, laser hemorrhoidoplasty device makers); MAUDE (complaint-level market signal) has no connector in this repo.

9. Open questions — and what would settle them

Class-3 questions are recorded here and never answered here.

10. Provenance & staleness

What this dossier has never looked at: grade-specific epidemiology and any US-population abandonment/recurrence figure for RBL, IRC, or sclerotherapy (everything comparative located is Dutch or Chinese); the full text of either ASCRS guideline (paywalled/unrenderable this pass); MAUDE narratives for any device named here (no connector exists); the CMS NCCI PTP edit-pair file (public, not yet fetched); device or consumable pricing for any of the five reference products in §5; user groups and incentives (§3, entirely unsearched); and any non-RF, non-anoscope competitive technology (laser hemorrhoidoplasty, Doppler-guided ligation systems). Absence of scanning is not absence of change — this file is a starting point for further research passes, not the output of one.

Sources

1. PMID 40824576 — "Hemorrhoidal Disease: A Review," JAMA, 2025.
2. PMID 42067175 — "AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review," Clinical Gastroenterology and Hepatology, 2026.
3. PMID 29420423 — "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids," Diseases of the Colon & Rectum, 2018.
4. PMID 38294832 — "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids," Diseases of the Colon & Rectum, 2024.
5. PMID 34633439 — "Interventional treatments for prolapsing haemorrhoids: network meta-analysis," BJS Open, 2021.
6. PMID 37117040 — "Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials," Postgraduate Medical Journal, 2023.
7. PMID 39952268 — "Comparison of Rubber Band Ligation and Hemorrhoidectomy in Patients With Symptomatic Hemorrhoids Grade III: A Multicenter, Open-Label, Randomized Controlled Noninferiority Trial," Diseases of the Colon & Rectum, 2025; trial registration NCT04621695.
8. PMID 41239416 — "Comparative effectiveness and recurrence rates of endoscopic sclerotherapy, ligation, and combined therapy for grades I-III internal hemorrhoids," BMC Surgery, 2025.
9. PMID 37059872 — "Comparison of the long-term efficacy and safety of multiple endoscopic rubber band ligations in a single session for varying grades of internal hemorrhoids," Irish Journal of Medical Science, 2023.
10. PMID 35725452 — "Modified rubber band ligation for treatment of grade II/III hemorrhoids: clinical efficacy and safety evaluation-a retrospective study," BMC Surgery, 2022.
11. PMID 39086750 — "Endoscopic polidocanol foam sclerobanding for the treatment of grade II-III internal hemorrhoids: A prospective, multi-center, randomized study," World Journal of Gastroenterology, 2024.
12. K121085 — FDA 510(k), HET Bipolar Electrocautery Forceps and Monitor, HET Systems, LLC, decided 2012-11-20.
13. K140422 — FDA 510(k), HET Bipolar Electrocautery Forceps and Monitor, HET Systems, LLC, decided 2014-06-05.
14. K200146 — FDA 510(k), HET Bipolar Electrocautery Forceps/Monitor, Covidien, LLC, decided 2020-05-07.
15. K030315 — FDA 510(k), Ultroid Hemorrhoid Management System, Ultroid, LLC, decided 2003-02-27.
16. K023706 — FDA 510(k), Ultroid Hemorrhoid Management System, Ultroid, LLC, decided 2003-01-14.
17. K250645 — FDA 510(k), SleeveLUX 24/16 Anoscope/Proctoscope, Haemoband Surgical, Ltd., decided 2025-10-09.
18. K162802 — FDA 510(k), Barrx Anorectal RFA Wand, Covidien, LLC, decided 2017-01-24.
19. K150251 — FDA 510(k), Barrx Anorectal RFA Wand, Covidien, LLC, decided 2015-07-28.
20. K130283 / K210077 / K253918 — FDA 510(k)s, EVRF System / MED RF 4000 / Veineo System, F Care Systems NV / F Care Systems USA, LLC, decided 2013-03-07 / 2021-12-17 / 2026-06-02.
21. K131282 — FDA 510(k), Nexus Hemorrhoid Ligator, Inx Medical, decided 2013-07-11.
22. K083781 — FDA 510(k), EEA Hemorrhoid Stapler & Accessories, Covidien, decided 2009-02-04.
23. FDA device recalls Z-0782-2017, Z-0783-2017, Z-0784-2017, Z-0785-2017 — Ultroid Technologies, Inc., recall initiated 2016-10-19, status Terminated, related 510(k)s K023706/K030315.
24. CMS Medicare Physician Fee Schedule, "Indicators for 2026" (dataset identifier 7c7df311-5315-4f38-b9ed-fd62f8bebe11), pfs.data.cms.gov, HCPCS 46930 / 46945 / 46946.
25. openFDA device/classification — product codes GEI, KNS, FHN, FER.
26. eCFR title 21, sections 878.4400, 876.4300, 876.4400 (issue 2026-08-19).
27. NCT06170736 — "Radiofrequency Ablation vs Doppler-guided Haemorrhoidal Artery Ligation in the Treatment of Haemorrhoidal Disease," ClinicalTrials.gov, recruiting, no results posted.
28. NCT07333040 — "HELO Trial: Energy-Based Therapies vs. Conventional Hemorrhoidectomy for Grade III Hemorrhoids," ClinicalTrials.gov, recruiting, no results posted.