CPT code 51940: Bladder repair, exstrophy correction2026 Medicare rate & RVUs in Illinois
Reports surgical reconstruction of bladder exstrophy, including correction of the exposed bladder defect, with or without an osteotomy.
CMS doesn’t publish an office rate for 51940 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 51940 covers
This code describes operative correction of bladder exstrophy, a congenital defect in which the bladder is exposed through an opening in the lower abdominal wall. Reconstruction addresses the bladder defect and its associated abdominal-wall opening; an osteotomy may be part of the operation. Pediatric urologists typically perform the procedure in a hospital operating room, often as part of a planned reconstructive course.
Report 51940 when the operative service is correction of bladder exstrophy, rather than closure of a fistula or repair of a bladder-vaginal lesion. The operative report should identify the exstrophy and describe the reconstruction, including whether an osteotomy was performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is not appropriate for this procedure.
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 51940 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 | $1,632.11 |
| East St. Louis, IL | Unavailable | $1,560.94 |
| Rest of Illinois | Unavailable | $1,500.64 |
| Suburban Chicago, IL | Unavailable | $1,572.12 |
How the 51940 rate is calculated
Each of 51940’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 · 51940
RVUs × geographic indexes × conversion factor
Work29.89
29.89 RVUs× 1.000 GPCI
Practice expense9.88
9.88 RVUs× 1.000 GPCI
Malpractice3.85
3.85 RVUs× 1.000 GPCI
Adjusted RVUs
43.6200
Conversion factor
$33.4009
Medicare rate
$1,456.95
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 51940
51940 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 51940
Bladder repair, exstrophy correction
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 51940
Bladder repair, exstrophy correction
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 51 · payment effect
With and without the modifier
51940 without 51 · national facility
$1,456.95
Bladder repair, exstrophy correction
51940-51 · Second procedure: 50%
$728.48
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
51940 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 51900Fistula repairVaginal approach
- 51900 addresses a bladder-vaginal lesion. Choose 51940 when the operative diagnosis is bladder exstrophy rather than a lesion involving the bladder and vagina.
- 51920Fistula repairBladder-to-uterus connection
- 51920 is for closure of a bladder-uterus fistula. It does not describe reconstruction of bladder exstrophy.
- 51925Fistula repairWith hysterectomy
- 51925 concerns bladder repair associated with hysterectomy, rather than correction of a congenital bladder exstrophy defect.
51940 billing questions
When should 51940 be selected instead of a bladder fistula repair code?
Use 51940 for correction of bladder exstrophy. Codes for vesicovaginal or vesicouterine fistula repair address abnormal connections between organs, not the congenital exstrophy defect.
Does the code include an osteotomy when one is performed?
The service is described as correction of bladder exstrophy with or without osteotomy. Document whether an osteotomy was performed as part of the reconstruction.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
Should modifier 50 be used?
No. Modifier 50 is inappropriate for this bladder exstrophy correction.
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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