CPT code 53449: Sphincter repair, urinary sphincter2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $543.50 for 53449 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 53449 nationwide

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

What 53449 covers

A urologist, often one specializing in reconstructive surgery, reports this service when an operation directly repairs the urinary sphincter. It is distinct from placing or exchanging an artificial urinary sphincter and from urethral reconstruction. The operative report should identify the sphincter defect and describe the repair performed; the service is generally provided in an operating-room setting.

Report the code when the documented work is sphincter repair, rather than device insertion, removal, or replacement. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery 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.

How Virginia compares for 53449

Across 109 of 109 payment localities, the facility rate for 53449 runs from $513.81 in Arkansas to $722.65 in Alaska. Virginia pays $543.50. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

53449 rates by state

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

See 53449 in every payment locality

How the 53449 rate is calculated

Each of 53449’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 53449

53449 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

Codes related to 53449

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

How 53449 has changed in Virginia

Price 53449 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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