CPT code 50405: Pyeloplasty, extensive or secondary reconstruction2026 Medicare rate & RVUs in Illinois
Reports complex surgical reconstruction of the renal pelvis and proximal ureter when extensive dissection or secondary repair is needed to restore drainage.
CMS doesn’t publish an office rate for 50405 in Illinois.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 50405 covers
A urologist uses this service to reconstruct the renal pelvis and upper ureter, commonly to relieve obstruction at the ureteropelvic junction. The repair may address recurrent narrowing after an earlier operation or a complex congenital or acquired obstruction that requires extensive dissection or reconstruction. This is an open surgical procedure generally performed in a facility operating room.
Choose this code based on the work documented in the operative report, not the diagnosis alone. The note should support the complexity of the repair, such as secondary reconstruction or extensive dissection; a less involved repair may fit 50400 instead. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral performance and pays at 150%. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 50405 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $1,391.02 |
| East St. Louis, IL | Unavailable | $1,329.79 |
| Rest of Illinois | Unavailable | $1,278.93 |
| Suburban Chicago, IL | Unavailable | $1,340.87 |
How the 50405 rate is calculated
Each of 50405’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 50405
RVUs × geographic indexes × conversion factor
Work25.21
25.21 RVUs× 1.000 GPCI
Practice expense8.78
8.78 RVUs× 1.000 GPCI
Malpractice3.24
3.24 RVUs× 1.000 GPCI
Adjusted RVUs
37.2300
Conversion factor
$33.4009
Medicare rate
$1,243.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50405
50405 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 50405
Pyeloplasty, extensive or secondary reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 50405
Pyeloplasty, extensive or secondary reconstruction
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50405 without 50 · national facility
$1,243.52
Pyeloplasty, extensive or secondary reconstruction
50405-50 · Bilateral: 150%
$1,865.28
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
50405 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50400PyeloplastySimple open reconstruction
- 50400 represents a less involved open pyeloplasty. Choose 50405 when the operative report supports a complicated repair, such as secondary reconstruction or extensive dissection.
- 50544PyeloplastyLaparoscopic approach
- 50544 is the laparoscopic pyeloplasty option. Use 50405 for the open approach when the repair is complicated.
- 50432Nephrostomy placementNew percutaneous access
- 50432 reports nephrostomy catheter placement for drainage. It does not describe definitive reconstruction of the renal pelvis and proximal ureter.
50405 billing questions
How does 50405 differ from 50400?
Use 50405 when the operative work involves a complicated repair, such as secondary reconstruction or extensive dissection. A less involved pyeloplasty may fit 50400.
Can 50405 be used for laparoscopic pyeloplasty?
No. For laparoscopic pyeloplasty, consider 50544; 50405 represents the open approach.
What documentation supports 50405?
The operative report should describe the reconstruction and the work supporting its complexity, such as a secondary repair or extensive dissection. A diagnosis of ureteropelvic junction obstruction alone does not establish the level of work.
What is included in the 90-day global period?
The day-before preoperative visit and related postoperative care during the 90 days after surgery are included.
How are bilateral procedures and multiple procedures handled?
Modifier 50 identifies bilateral performance and is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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