CPT code 51820: Outlet reconstruction, complicated plastic repair2026 Medicare rate & RVUs

Medicare pays $974.97 for 51820 nationally in a facility.

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

What 51820 covers

A urologist performs this reconstructive operation to correct a complex abnormality involving the urethra or bladder neck. It may be used for congenital or acquired structural problems, including defects encountered after prior surgery. The surgeon reshapes or reconstructs the affected outlet anatomy in an operating room; this is distinct from simply closing a bladder wound or supporting pelvic organs for prolapse or incontinence.

Report the code when the operative work supports a complicated reconstructive repair, rather than the less complex related procedure. The operative note should identify the affected anatomy, the underlying problem, and the reconstructive work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; 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 51820 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

51820 rates by state

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

How the 51820 rate is calculated

Each of 51820’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.

Payment rules and modifiers for 51820

51820 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

51820 compared with similar codes

How to choose

51800Bladder outlet reconstructionBladder neck and urethra

Both address urethral or bladder-neck reconstruction, but 51820 represents the complicated service; 51800 is the less complex related code.

51860Bladder repairSimple wound suture

51860 is for simple closure of a bladder wound. Choose 51820 when the operation reconstructs a complex urethral or bladder-neck abnormality instead.

51865Bladder wound repairComplicated repair

51865 concerns complicated repair of a bladder wound, while 51820 describes complicated reconstruction of the urethra or bladder neck.

51845Bladder neck repairRetropubic abdominal suspension

51845 is a bladder-neck suspension procedure for stress incontinence; 51820 addresses reconstructive correction of abnormal outlet anatomy.

Codes related to 51820

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

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

Open CMS sourceHow we calculate rates