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CPT code 50590: Kidney stone treatment, shock-wave lithotripsy2026 Medicare rate & RVUs in Hawaii, Guam, HI

Reports external shock-wave treatment to fragment a kidney stone, typically performed by a urologist without endoscopic or percutaneous stone access.

CMS RVU26DEffective Oct 1, 2026One payment locality41.9K Medicare services in 2024

In Hawaii, Guam, HI, Medicare pays $797.82 for 50590 in the office and $525.91 when it’s performed in a hospital or facility.

$797.82Office (non-facility)
$525.91Hospital or facility
+4.9%vs the national office rate ($760.20)

Check a contract rate as a % of Medicare · 50590 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 50590 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Hawaii, Guam, HI
  2. What 50590 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 50590 covers

This service uses externally generated shock waves, directed toward a renal calculus, to break it into smaller pieces. A urologist typically performs the treatment in a hospital or ambulatory setting, using imaging to locate and target the stone. Unlike endoscopic or percutaneous stone procedures, treatment does not require access through the urinary tract or a percutaneous tract to reach the stone.

Report the service when the documented procedure is shock-wave fragmentation of a kidney stone. The record should support the treated kidney and the use of this treatment method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are 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.

How Hawaii, Guam, HI compares for 50590

Across 109 of 109 payment localities, the office rate for 50590 runs from $683.76 in Arkansas to $953.31 in San Benito County, CA. Hawaii, Guam, HI pays $797.82. The RVUs are the same everywhere; the geographic indexes change the dollars.

50590 in Hawaii, Guam, HI vs other payment areas
  1. Hawaii, Guam, HI · this page$797.82
  2. Los Angeles, CA · California$832.80+$34.98
  3. Washington, DC area · District of Columbia$853.38+$55.56
  4. Miami, FL · Florida$839.45+$41.63
  5. Chicago, IL · Illinois$817.64+$19.82
  6. Manhattan, NY · New York$869.58+$71.76
  7. Alaska · Alaska$926.97+$129.15

Other areas in Hawaii first, then benchmark localities. Bars start at $0.

Every other payment area

50590 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$692.27$483.02
ArkansasArkansas$683.76$478.33
ArizonaArizona$741.86$510.13
Bakersfield, CACalifornia$788.67$526.56
Chico, CACalifornia$785.03$522.92
El Centro, CACalifornia$785.24$523.13
Fresno, CACalifornia$785.03$522.92
Hanford, CACalifornia$785.03$522.92

50590 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$683.76

$926.97

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
50590 office rate range by state
State / territoryOffice rate rangeLocalities
AK$926.971
AL$692.271
AR$683.761
AZ$741.861
CA$785.03–$953.3129
CO$780.681
CT$806.061
DC$853.381
DE$752.841
FL$763.23–$839.453
GA$724.80–$775.832
GU$797.821
HI$797.821
IA$701.361
ID$706.491
IL$748.46–$817.644
IN$709.831
KS$701.351
KY$712.221
LA$712.39–$742.142
MA$778.20–$846.492
MD$764.83–$853.383
ME$712.61–$741.442
MI$730.63–$774.362
MN$742.911
MO$703.82–$741.053
MS$693.771
MT$760.121
NC$718.521
ND$735.801
NE$703.791
NH$771.501
NJ$813.80–$847.182
NM$735.191
NV$753.741
NY$727.96–$891.545
OH$725.661
OK$708.161
OR$746.40–$799.272
PA$725.08–$790.302
PR$764.001
RI$775.041
SC$723.581
SD$732.931
TN$704.711
TX$721.21–$779.408
UT$731.971
VA$741.31–$853.382
VI$764.001
VT$735.901
WA$775.77–$859.592
WI$714.941
WV$725.411
WY$749.521

See 50590 in every payment locality

How the 50590 rate is calculated

Each of 50590’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 · 50590

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.53

9.53 RVUs× 1.000 GPCI

Practice expense12.00

12.00 RVUs× 1.000 GPCI

Malpractice1.23

1.23 RVUs× 1.000 GPCI

Adjusted RVUs

22.7600

Conversion factor

$33.4009

Medicare rate

$760.20

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Hawaii, Guam, HI inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

5,952

Code
50590
Physician work
9.53
Practice expense
12.00
Malpractice
1.23

GPCI2026.csv

46

Locality
Hawaii, Guam, HI
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office calculation for 50590 in Hawaii, Guam, HI
ComponentRVULocality factorAdjusted
Physician work9.53× 1.0009.5300
Practice expense12.00× 1.13713.6440
Malpractice1.23× 0.5790.7122
Total RVUs23.8862
Conversion factor× 33.4009

Office rate, Hawaii, Guam, HI$797.82

Office: (9.53 × 1 + 12 × 1.137 + 1.23 × 0.579) × $33.4009 = $797.82

Facility: (9.53 × 1 + 4.84 × 1.137 + 1.23 × 0.579) × $33.4009 = $525.91

Open 50590 in the RVU calculator

Payment rules and modifiers for 50590

50590 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 50590

Kidney stone treatment, shock-wave lithotripsy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.08/0.83/0.09Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 50590

Kidney stone treatment, shock-wave lithotripsy

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

50590 without 50 · national office

$760.20

Kidney stone treatment, shock-wave lithotripsy

50590-50 · Bilateral: 150%

$1,140.30

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).

When to use modifier 50

Codes related to 50590

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 50590
CodeHow it relatesOffice range, Hawaii, Guam, HI
Used instead
52353Stone lithotripsy, ureteroscopy or pyeloscopyUreteroscopic stone fragmentation is an alternative when the stone is reached endoscopically.No office rate
50080Percutaneous stone removal, simple, up to 2 cmPercutaneous stone removal with fragmentation is an alternative using a percutaneous tract.No office rate
50081Kidney stone removal, stone burden over 2 cmComplex percutaneous stone removal with fragmentation is an alternative for cases requiring that approach.No office rate

How 50590 has changed in Hawaii, Guam, HI

50590 · Office / nonfacility

$797.82

Effective 2026-10-01

The base rate is $43.56 higher than on 2025-10-01, moving from $754.26 to $797.82 (5.8%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $754.26changed to$797.82

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 9.77 changed to 9.53
    • Practice expense RVU 11.22 changed to 12.00
    • Malpractice RVU 1.17 changed to 1.23
    • Practice expense GPCI 1.149 changed to 1.137
    • Malpractice GPCI 0.561 changed to 0.579

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $779.24changed to$754.26

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 11.28 changed to 11.22
    • Malpractice RVU 1.21 changed to 1.17

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $766.53changed to$779.24

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $786.83changed to$766.53

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.09 changed to 11.28
    • Malpractice RVU 1.15 changed to 1.21
    • Work GPCI 1.003 changed to 1.000
    • Practice expense GPCI 1.146 changed to 1.149
    • Malpractice GPCI 0.618 changed to 0.561

  5. January 1, 2023

    RVU23A

    $805.90changed to$786.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 11.05 changed to 11.09
    • Malpractice RVU 1.17 changed to 1.15
    • Work GPCI 1.010 changed to 1.003
    • Practice expense GPCI 1.143 changed to 1.146
    • Malpractice GPCI 0.675 changed to 0.618

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $811.07changed to$805.90

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 11.03 changed to 11.05
    • Malpractice RVU 1.14 changed to 1.17

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $804.99changed to$811.07

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 10.27 changed to 11.03
    • Malpractice RVU 1.13 changed to 1.14
    • Work GPCI 1.006 changed to 1.010
    • Practice expense GPCI 1.144 changed to 1.143
    • Malpractice GPCI 0.644 changed to 0.675

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $795.56changed to$804.99

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.15 changed to 10.27
    • Malpractice RVU 1.08 changed to 1.13
    • Work GPCI 1.001 changed to 1.006
    • Practice expense GPCI 1.146 changed to 1.144
    • Malpractice GPCI 0.614 changed to 0.644

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $786.85changed to$795.56

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.96 changed to 10.15

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $781.08changed to$786.85

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.80 changed to 9.96
    • Work GPCI 1.002 changed to 1.001
    • Practice expense GPCI 1.154 changed to 1.146
    • Malpractice GPCI 0.616 changed to 0.614

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $777.29changed to$781.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.67 changed to 9.80
    • Malpractice RVU 1.09 changed to 1.08
    • Work GPCI 1.003 changed to 1.002
    • Practice expense GPCI 1.162 changed to 1.154
    • Malpractice GPCI 0.618 changed to 0.616

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $779.26changed to$777.29

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.65 changed to 9.67

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $775.38changed to$779.26

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $768.33changed to$775.38

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.55 changed to 9.65
    • Malpractice RVU 0.91 changed to 1.09
    • Work GPCI 1.002 changed to 1.003
    • Practice expense GPCI 1.158 changed to 1.162
    • Malpractice GPCI 0.659 changed to 0.618

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $758.26changed to$768.33

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.27 changed to 9.55
    • Malpractice RVU 0.95 changed to 0.91
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.154 changed to 1.158
    • Malpractice GPCI 0.700 changed to 0.659

    Held through RVU14B, RVU14C, RVU14D.

  16. October 1, 2013

    RVU13D

    No ratechanged to$758.26

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$797.82$525.91RVU26D
2026-07-01$797.82$525.91RVU26C
2026-04-01$797.82$525.91RVU26B
2026-01-01$797.82$525.91RVU26A
2025-10-01$754.26$571.77RVU25D
2025-07-01$754.26$571.77RVU25C
2025-04-01$754.26$571.77RVU25B
2025-01-01$754.26$571.77RVU25A
2024-10-01$779.24$583.80RVU24D
2024-07-01$779.24$583.80RVU24C
2024-04-01$779.24$583.80RVU24B
2024-03-09$779.24$583.80RVU24AR
2024-01-01$766.53$574.27RVU24A
2023-10-01$786.83$587.22RVU23D
2023-07-01$786.83$587.22RVU23C
2023-04-01$786.83$587.22RVU23B
2023-01-01$786.83$587.22RVU23A
2022-10-01$805.90$597.44RVU22D
2022-07-01$805.90$597.44RVU22C
2022-04-01$805.90$597.44RVU22B
2022-01-01$805.90$597.44RVU22A
2021-10-01$811.07$599.29RVU21D
2021-07-01$811.07$599.29RVU21C
2021-04-01$811.07$599.29RVU21B
2021-01-01$811.07$599.29RVU21A
2020-10-01$804.99$608.88RVU20D
2020-07-01$804.99$608.88RVU20C
2020-04-01$804.99$608.88RVU20B
2020-01-01$804.99$608.88RVU20A
2019-10-01$795.56$607.64RVU19D
2019-07-01$795.56$607.64RVU19C
2019-04-01$795.56$607.64RVU19B
2019-01-01$795.56$607.64RVU19A
2018-10-01$786.85$607.80RVU18D
2018-07-01$786.85$607.80RVU18C
2018-04-01$786.85$607.80RVU18B
2018-01-01$786.85$607.80RVU18AR1
2017-10-01$781.08$604.65RVU17D
2017-07-01$781.08$604.65RVU17C
2017-04-01$781.08$604.65RVU17B
2017-01-01$781.08$604.65RVU17A
2016-10-01$777.29$602.14RVU16D
2016-07-01$777.29$602.14RVU16C
2016-04-01$777.29$602.14RVU16B
2016-01-01$777.29$602.14RVU16A
2015-10-01$779.26$602.64RVU15D
2015-07-01$779.26$602.64RVU15C
2015-04-01$775.38$599.64RVU15B
2015-01-01$775.38$599.64RVU15A
2014-10-01$768.33$596.59RVU14D
2014-07-01$768.33$596.59RVU14C
2014-04-01$768.33$596.59RVU14B
2014-01-01$768.33$596.59RVU14A
2013-10-01$758.26$580.00RVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 50590 for an earlier date of service

Where the Hawaii, Guam, HI rate applies

Hawaii, Guam, HI is a Medicare payment area, not a city. Our Census mapping connects it to 163 cities and communities in Hawaii. Some span more than one payment area; confirm with the service ZIP.

  • Ahuimanu
  • Aiea
  • Ainaloa
  • Anahola
  • Black Sands
  • Captain Cook
  • Discovery Harbour
  • East Honolulu

Browse all communities in Hawaii

50590 billing questions

How does this differ from ureteroscopic stone treatment?

This code is for externally delivered shock waves directed at a kidney stone. Ureteroscopic treatment uses an endoscope passed through the urinary tract to reach and treat a stone.

Does the global period include routine follow-up?

Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.

How is bilateral treatment reported?

When both kidneys are treated, report modifier 50; CMS pays the bilateral procedure at 150%.

How does the multiple-procedure reduction affect payment?

When procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.

Can an assistant or co-surgeon be reported?

CMS does not pay assistant-at-surgery services for this code. Co-surgeons and team surgery are 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

Show the CMS file lines behind this rate
RVUs for 50590PPRRVU2026_Oct_nonQPP.csv, line 5,952 (RVU26D)
Geographic factors for Hawaii, Guam, HIGPCI2026.csv, line 46 (RVU26D)

Open CMS sourceHow we calculate rates

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