CPT code 90586: Intravesical BCG, bladder cancer treatment2026 Medicare rate & RVUs in Guam
Intravesical BCG is the live BCG product used for bladder cancer immunotherapy, reported when the product is instilled into the bladder.
CMS doesn’t publish an office rate for 90586 in Guam.
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 90586 covers
This code identifies live BCG used as intravesical immunotherapy for bladder cancer, including non-muscle-invasive disease such as carcinoma in situ. A urologist or other qualified clinician administers the product through a urinary catheter, commonly during an outpatient treatment course after resection of bladder tumors. The BCG product is distinct from the service of instilling it into the bladder.
CMS assigns this code physician fee schedule status E, which excludes it from the physician fee schedule. When Medicare covers the item or service, payment is made under another payment method. Report one unit for each instillation; the unit is not based on the amount of BCG in the dose. Code 51720 represents the bladder instillation service when applicable. This code is for intravesical BCG, not percutaneous BCG vaccination against tuberculosis.
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.
90586 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
How the 90586 rate is calculated
Each of 90586’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 · 90586
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90586
90586 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 90586
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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90586 isn’t priced in this setting.
90586 compared with similar codes
Compare codes · National
90586 vs 51720 vs 90585: Medicare rates
How to choose
- 51720Bladder instillationAntineoplastic agent
- 90586 identifies the intravesical BCG product; 51720 represents the bladder instillation service. They describe different parts of the treatment.
- 90585BCG vaccinePercutaneous route
- 90585 is for percutaneous BCG vaccination. Use 90586 for BCG used intravesically as bladder cancer immunotherapy.
90586 billing questions
When should I report 90586 instead of 90585?
Report 90586 for BCG used intravesically as bladder cancer immunotherapy. Code 90585 identifies BCG given percutaneously.
Does 90586 include the bladder instillation?
90586 identifies the BCG product. Code 51720 represents the bladder instillation service when that service is performed and separately reported.
How many units should I report?
Report one unit for each BCG instillation. The unit is not based on the amount of BCG in the dose.
What documentation supports reporting 90586?
Document the BCG product administered, its intravesical route, and the bladder cancer treatment encounter. The record should distinguish the product from the instillation service.
How does Medicare treat 90586?
CMS assigns status E, excluding the code from the physician fee schedule. When Medicare covers the item or service, payment is made under another payment method.
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.
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