CPT code 53865: Prostate remodeling, temporary implant insertion2026 Medicare rate & RVUs in Connecticut
A urologist inserts a temporary transprostatic remodeling device cystoscopically to reshape the prostatic urethra in patients treated for urinary obstruction.
In Connecticut, Medicare pays $3,320.23 for 53865 in the office and $152.82 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 53865 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 53865 covers
A urologist passes a cystoscope through the urethra and places a temporary implant in the prostatic urethra. The device applies pressure that produces localized ischemic remodeling, creating channels through obstructing prostate tissue. The procedure is used for lower urinary tract symptoms related to benign prostatic enlargement and is performed in an outpatient procedural setting under cystoscopic visualization. The device is removed in a later procedure.
Report 53865 for the insertion procedure, supported by documentation of the indication, cystoscopic placement, and device insertion. Same-day preoperative and postoperative care is included in its 0-day global period. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing 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 Connecticut compares for 53865
Across 109 of 109 payment localities, the office rate for 53865 runs from $2,661.11 in Arkansas to $4,405.55 in San Benito County, CA. Connecticut pays $3,320.23. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Connecticut · this page$3,320.23
- Los Angeles, CA · California$3,630.34+$310.11
- Washington, DC area · District of Columbia$3,622.63+$302.40
- Miami, FL · Florida$3,228.37−$91.86
- Chicago, IL · Illinois$3,119.02−$201.21
- Manhattan, NY · New York$3,582.24+$262.01
- Alaska · Alaska$3,324.39+$4.16
Other areas in Connecticut first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $2,709.34 | $136.01 |
| ArkansasArkansas | $2,661.11 | $134.84 |
| ArizonaArizona | $2,992.55 | $142.77 |
| Bakersfield, CACalifornia | $3,368.78 | $145.50 |
| Chico, CACalifornia | $3,367.63 | $144.34 |
| El Centro, CACalifornia | $3,367.69 | $144.41 |
| Fresno, CACalifornia | $3,367.63 | $144.34 |
| Hanford, CACalifornia | $3,367.63 | $144.34 |
| Madera, CACalifornia | $3,367.63 | $144.34 |
| Merced, CACalifornia | $3,367.63 | $144.34 |
| Modesto, CACalifornia | $3,367.63 | $144.34 |
| Napa, CACalifornia | $4,031.84 | $155.66 |
| Oxnard, CACalifornia | $3,625.52 | $149.32 |
| Redding, CACalifornia | $3,367.63 | $144.34 |
| Rest of CaliforniaCalifornia | $3,367.63 | $144.34 |
| Riverside, CACalifornia | $3,371.86 | $148.57 |
| Sacramento, CACalifornia | $3,568.71 | $148.39 |
| Salinas, CACalifornia | $3,556.32 | $147.76 |
| San Diego, CACalifornia | $3,666.28 | $148.91 |
| Marin County, CACalifornia | $4,307.91 | $161.17 |
| San Francisco, CACalifornia | $4,307.47 | $160.73 |
| San Benito County, CACalifornia | $4,405.55 | $164.70 |
| Santa Clara County, CACalifornia | $4,403.74 | $162.89 |
| San Luis Obispo, CACalifornia | $3,495.45 | $145.71 |
| Santa Cruz, CACalifornia | $3,721.78 | $148.52 |
| Santa Maria, CACalifornia | $3,576.82 | $147.68 |
| Santa Rosa, CACalifornia | $3,761.33 | $149.84 |
| Stockton, CACalifornia | $3,367.63 | $144.34 |
| Vallejo, CACalifornia | $4,031.20 | $155.03 |
| Visalia, CACalifornia | $3,367.63 | $144.34 |
| Yuba City, CACalifornia | $3,367.63 | $144.34 |
| ColoradoColorado | $3,275.19 | $146.02 |
| DelawareDelaware | $3,050.09 | $144.44 |
| Fort Lauderdale, FLFlorida | $3,135.75 | $156.57 |
| Rest of FloridaFlorida | $2,962.33 | $150.78 |
| Atlanta, GAGeorgia | $3,137.06 | $149.06 |
| Rest of GeorgiaGeorgia | $2,768.03 | $144.70 |
| Hawaii, Guam, HIHawaii | $3,488.35 | $144.49 |
| IowaIowa | $2,826.04 | $135.08 |
| IdahoIdaho | $2,841.90 | $136.22 |
| East St. Louis, ILIllinois | $2,861.97 | $156.30 |
| Rest of IllinoisIllinois | $2,835.29 | $150.20 |
| Suburban Chicago, ILIllinois | $3,177.60 | $157.25 |
| IndianaIndiana | $2,862.88 | $136.62 |
| KansasKansas | $2,794.74 | $136.12 |
| KentuckyKentucky | $2,755.50 | $141.00 |
| New Orleans, LALouisiana | $2,912.96 | $145.53 |
| Rest of LouisianaLouisiana | $2,744.17 | $141.43 |
| Metropolitan Boston, MAMassachusetts | $3,665.98 | $154.49 |
| Rest of MassachusettsMassachusetts | $3,243.10 | $146.28 |
| Baltimore area, MDMaryland | $3,308.28 | $152.65 |
| Rest of MarylandMaryland | $3,122.19 | $145.95 |
| Rest of MaineMaine | $2,843.84 | $138.17 |
| Southern Maine, MEMaine | $3,055.02 | $140.54 |
| Detroit, MIMichigan | $2,991.47 | $153.45 |
| Rest of MichiganMichigan | $2,829.63 | $144.55 |
| MinnesotaMinnesota | $3,163.61 | $137.38 |
| Metropolitan Kansas City, MOMissouri | $2,904.94 | $143.39 |
| Metropolitan St. Louis, MOMissouri | $2,943.91 | $144.13 |
| Rest of MissouriMissouri | $2,676.01 | $140.91 |
| MississippiMississippi | $2,669.97 | $137.82 |
| MontanaMontana | $3,086.55 | $145.60 |
| North CarolinaNorth Carolina | $2,882.71 | $138.80 |
| North DakotaNorth Dakota | $3,078.84 | $137.89 |
| NebraskaNebraska | $2,849.58 | $135.08 |
| New HampshireNew Hampshire | $3,206.83 | $145.30 |
| Northern New JerseyNew Jersey | $3,569.45 | $157.95 |
| Rest of New JerseyNew Jersey | $3,365.36 | $153.85 |
| New MexicoNew Mexico | $2,842.46 | $145.61 |
| NevadaNevada | $3,087.37 | $143.48 |
| NYC suburbs and Long Island, NYNew York | $3,666.03 | $169.24 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $3,376.26 | $155.92 |
| Queens, NYNew York | $3,639.82 | $163.62 |
| Rest of New YorkNew York | $2,934.07 | $140.17 |
| OhioOhio | $2,828.06 | $142.97 |
| OklahomaOklahoma | $2,765.60 | $139.33 |
| Portland, OROregon | $3,414.82 | $147.43 |
| Rest of OregonOregon | $3,070.82 | $141.63 |
| Metropolitan Philadelphia, PAPennsylvania | $3,212.79 | $151.26 |
| Rest of PennsylvaniaPennsylvania | $2,842.10 | $142.31 |
| Puerto RicoPuerto Rico | $3,119.08 | $145.78 |
| Rhode IslandRhode Island | $3,185.19 | $147.18 |
| South CarolinaSouth Carolina | $2,858.70 | $141.26 |
| South DakotaSouth Dakota | $3,077.93 | $136.98 |
| TennesseeTennessee | $2,810.03 | $136.71 |
| Austin, TXTexas | $3,257.71 | $146.19 |
| Beaumont, TXTexas | $2,818.11 | $141.85 |
| Brazoria, TXTexas | $3,057.76 | $143.28 |
| Dallas, TXTexas | $3,073.74 | $144.56 |
| Fort Worth, TXTexas | $3,044.19 | $144.41 |
| Galveston, TXTexas | $3,064.33 | $143.97 |
| Houston, TXTexas | $3,071.47 | $151.11 |
| Rest of TexasTexas | $2,933.71 | $142.75 |
| UtahUtah | $2,906.89 | $142.40 |
| VirginiaVirginia | $3,032.21 | $141.26 |
| Virgin Islands, VIUnited States Virgin Islands | $3,119.08 | $145.78 |
| VermontVermont | $3,050.42 | $138.88 |
| Rest of WashingtonWashington | $3,242.33 | $145.51 |
| King County, WAWashington | $3,764.04 | $155.49 |
| WisconsinWisconsin | $2,952.71 | $135.28 |
| West VirginiaWest Virginia | $2,702.77 | $147.09 |
| WyomingWyoming | $3,083.19 | $142.24 |
53865 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$2,661.11
$3,886.59
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $3,324.39 | 1 |
| AL | $2,709.34 | 1 |
| AR | $2,661.11 | 1 |
| AZ | $2,992.55 | 1 |
| CA | $3,367.63–$4,405.55 | 29 |
| CO | $3,275.19 | 1 |
| CT | $3,320.23 | 1 |
| DC | $3,622.63 | 1 |
| DE | $3,050.09 | 1 |
| FL | $2,962.33–$3,228.37 | 3 |
| GA | $2,768.03–$3,137.06 | 2 |
| GU | $3,488.35 | 1 |
| HI | $3,488.35 | 1 |
| IA | $2,826.04 | 1 |
| ID | $2,841.90 | 1 |
| IL | $2,835.29–$3,177.60 | 4 |
| IN | $2,862.88 | 1 |
| KS | $2,794.74 | 1 |
| KY | $2,755.50 | 1 |
| LA | $2,744.17–$2,912.96 | 2 |
| MA | $3,243.10–$3,665.98 | 2 |
| MD | $3,122.19–$3,622.63 | 3 |
| ME | $2,843.84–$3,055.02 | 2 |
| MI | $2,829.63–$2,991.47 | 2 |
| MN | $3,163.61 | 1 |
| MO | $2,676.01–$2,943.91 | 3 |
| MS | $2,669.97 | 1 |
| MT | $3,086.55 | 1 |
| NC | $2,882.71 | 1 |
| ND | $3,078.84 | 1 |
| NE | $2,849.58 | 1 |
| NH | $3,206.83 | 1 |
| NJ | $3,365.36–$3,569.45 | 2 |
| NM | $2,842.46 | 1 |
| NV | $3,087.37 | 1 |
| NY | $2,934.07–$3,666.03 | 5 |
| OH | $2,828.06 | 1 |
| OK | $2,765.60 | 1 |
| OR | $3,070.82–$3,414.82 | 2 |
| PA | $2,842.10–$3,212.79 | 2 |
| PR | $3,119.08 | 1 |
| RI | $3,185.19 | 1 |
| SC | $2,858.70 | 1 |
| SD | $3,077.93 | 1 |
| TN | $2,810.03 | 1 |
| TX | $2,818.11–$3,257.71 | 8 |
| UT | $2,906.89 | 1 |
| VA | $3,032.21–$3,622.63 | 2 |
| VI | $3,119.08 | 1 |
| VT | $3,050.42 | 1 |
| WA | $3,242.33–$3,764.04 | 2 |
| WI | $2,952.71 | 1 |
| WV | $2,702.77 | 1 |
| WY | $3,083.19 | 1 |
How the 53865 rate is calculated
Each of 53865’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 · 53865
RVUs × geographic indexes × conversion factor
Work3.02
3.02 RVUs× 1.000 GPCI
Practice expense89.00
89.00 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
92.4100
Conversion factor
$33.4009
Medicare rate
$3,086.58
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Connecticut inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
6,232
- Code
- 53865
- Physician work
- 3.02
- Practice expense
- 89.00
- Malpractice
- 0.39
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.02 | × 1.020 | 3.0804 |
| Practice expense | 89.00 | × 1.077 | 95.8530 |
| Malpractice | 0.39 | × 1.210 | 0.4719 |
| Total RVUs | 99.4053 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Connecticut$3320.23
Office: (3.02 × 1.02 + 89 × 1.077 + 0.39 × 1.21) × $33.4009 = $3320.23
Facility: (3.02 × 1.02 + 0.95 × 1.077 + 0.39 × 1.21) × $33.4009 = $152.82
Payment rules and modifiers for 53865
The CMS indicators that decide how 53865 is paid alongside other services.
CMS payment indicators · 53865
Prostate remodeling, temporary implant insertion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
53865 without 51 · national office
$3,086.58
Prostate remodeling, temporary implant insertion
53865-51 · Second procedure: 50%
$1,543.29
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%).
How 53865 has changed in Connecticut
53865 · Office / nonfacility
$3320.23
Effective 2026-10-01
The base rate is $220.87 higher than on 2025-10-01, moving from $3099.36 to $3320.23 (7.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$3099.36changed to$3320.23
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.10 changed to 3.02
- Practice expense RVU 84.49 changed to 89.00
- Work GPCI 1.022 changed to 1.020
- Practice expense GPCI 1.091 changed to 1.077
- Malpractice GPCI 1.207 changed to 1.210
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
No ratechanged to$3099.36
Held through RVU25B, RVU25C, RVU25D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $3,320.23 | $152.82 | RVU26D |
| 2026-07-01 | $3,320.23 | $152.82 | RVU26C |
| 2026-04-01 | $3,320.23 | $152.82 | RVU26B |
| 2026-01-01 | $3,320.23 | $152.82 | RVU26A |
| 2025-10-01 | $3,099.36 | $167.82 | RVU25D |
| 2025-07-01 | $3,099.36 | $167.82 | RVU25C |
| 2025-04-01 | $3,099.36 | $167.82 | RVU25B |
| 2025-01-01 | $3,099.36 | $167.82 | RVU25A |
| 2024-10-01 | Not in this release | Not in this release | RVU24D |
| 2024-07-01 | Not in this release | Not in this release | RVU24C |
| 2024-04-01 | Not in this release | Not in this release | RVU24B |
| 2024-03-09 | Not in this release | Not in this release | RVU24AR |
| 2024-01-01 | Not in this release | Not in this release | RVU24A |
| 2023-10-01 | Not in this release | Not in this release | RVU23D |
| 2023-07-01 | Not in this release | Not in this release | RVU23C |
| 2023-04-01 | Not in this release | Not in this release | RVU23B |
| 2023-01-01 | Not in this release | Not in this release | RVU23A |
| 2022-10-01 | Not in this release | Not in this release | RVU22D |
| 2022-07-01 | Not in this release | Not in this release | RVU22C |
| 2022-04-01 | Not in this release | Not in this release | RVU22B |
| 2022-01-01 | Not in this release | Not in this release | RVU22A |
| 2021-10-01 | Not in this release | Not in this release | RVU21D |
| 2021-07-01 | Not in this release | Not in this release | RVU21C |
| 2021-04-01 | Not in this release | Not in this release | RVU21B |
| 2021-01-01 | Not in this release | Not in this release | RVU21A |
| 2020-10-01 | Not in this release | Not in this release | RVU20D |
| 2020-07-01 | Not in this release | Not in this release | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Connecticut rate applies
Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.
- Ansonia
- Ball Pond
- Baltic
- Bantam
- Bethel
- Bethlehem Village
- Bigelow Corners
- Blue Hills
53865 billing questions
How does this differ from code 52441?
Code 53865 describes placement of a temporary device that reshapes the prostatic urethra through ischemic remodeling. Code 52441 is for insertion of a permanent adjustable transprostatic implant.
Is the later device removal included?
No. Removal is a separate procedure reported with code 53866, rather than part of the insertion service.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this service.
Can an assistant or co-surgeon be reported?
Medicare does not pay for an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another endoscopy is performed in the same session?
When related endoscopies are performed together, CMS endoscopy-family pricing applies. The claim should reflect the procedures actually performed and documented.
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
Fee sheets
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