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Billing code 50405: PyeloplastyMedicare rate & RVUs

Reports complex surgical reconstruction of the renal pelvis and proximal ureter when extensive dissection or secondary repair is needed to restore drainage.

CMS RVU26DEffective Oct 1, 2026109 payment localities13 Medicare services in 2024

Medicare pays $1,243.52 for 50405 nationally in a facility.

Medicare rate · 50405

Pyeloplasty

Work RVUs
25.21
Total RVUs
37.23
Global days
090

National rate · 2026

$1,243.52

Facility setting, before claim adjustments.

See every locality for 50405 →Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 50405 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 50405 covers

A urologist uses this service to reconstruct the renal pelvis and upper ureter, commonly to relieve obstruction at the ureteropelvic junction. The repair may address recurrent narrowing after an earlier operation or a complex congenital or acquired obstruction that requires extensive dissection or reconstruction. This is an open surgical procedure generally performed in a facility operating room.

Choose this code based on the work documented in the operative report, not the diagnosis alone. The note should support the complexity of the repair, such as secondary reconstruction or extensive dissection; a less involved repair may fit 50400 instead. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 identifies bilateral performance and pays at 150%. Assistant-at-surgery services 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.

Where 50405 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

50405 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,159.89
Alaska*Unavailable$1,635.01
ArizonaUnavailable$1,218.84
ArkansasUnavailable$1,149.68
AtlantaUnavailable$1,272.49
AustinUnavailable$1,249.87
BakersfieldUnavailable$1,245.35
Baltimore/Surr. CntysUnavailable$1,304.04
BeaumontUnavailable$1,209.44
BrazoriaUnavailable$1,223.80

50405 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
50405 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 50405 rate is calculated

Each of 50405’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 · 50405

RVUs × geographic indexes × conversion factor

Work25.21

25.21 RVUs× 1.000 GPCI

Practice expense8.78

8.78 RVUs× 1.000 GPCI

Malpractice3.24

3.24 RVUs× 1.000 GPCI

Adjusted RVUs

37.2300

Conversion factor

$33.4009

Medicare rate

$1,243.52

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 50405

50405 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 50405

Pyeloplasty

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.08/0.83/0.09Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 50405

Pyeloplasty

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

50405 without 50 · national facility

$1,243.52

Pyeloplasty

50405-50 · Bilateral: 150%

$1,865.28

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

50405 compared with similar codes

Compare codes · National

4 codes, side by side

  • 50405

    Pyeloplasty25.21 wRVU

    Not priced

  • 50400

    Pyeloplasty20.74 wRVU

    Not priced

  • 50544

    Pyeloplasty22.79 wRVU

    Not priced

  • 50432

    Nephrostomy placement3.9 wRVU

    $864.08

How to choose

50400Pyeloplasty
50400 represents a less involved open pyeloplasty. Choose 50405 when the operative report supports a complicated repair, such as secondary reconstruction or extensive dissection.
50544Pyeloplasty
50544 is the laparoscopic pyeloplasty option. Use 50405 for the open approach when the repair is complicated.
50432Nephrostomy placement
50432 reports nephrostomy catheter placement for drainage. It does not describe definitive reconstruction of the renal pelvis and proximal ureter.

Codes related to 50405

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

Codes related to 50405
CodeHow it relatesNational office range
Same family
50400PyeloplastyLess involved pyeloplasty in the same open surgical code family.No office rate
Used instead
50544PyeloplastyLaparoscopic approach for pyeloplasty rather than the open approach represented by 50405.No office rate
Often billed with
52332Ureteral stentA ureteral stent may be placed during pyeloplasty; assess whether distinct work supports separate reporting.$329.01–$496.12

50405 billing questions

How does 50405 differ from 50400?

Use 50405 when the operative work involves a complicated repair, such as secondary reconstruction or extensive dissection. A less involved pyeloplasty may fit 50400.

Can 50405 be used for laparoscopic pyeloplasty?

No. For laparoscopic pyeloplasty, consider 50544; 50405 represents the open approach.

What documentation supports 50405?

The operative report should describe the reconstruction and the work supporting its complexity, such as a secondary repair or extensive dissection. A diagnosis of ureteropelvic junction obstruction alone does not establish the level of work.

What is included in the 90-day global period?

The day-before preoperative visit and related postoperative care during the 90 days after surgery are included.

How are bilateral procedures and multiple procedures handled?

Modifier 50 identifies bilateral performance and is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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
RVUs for 50405PPRRVU2026_Oct_nonQPP.csv, line 5,916 (RVU26D)

Open CMS sourceHow we calculate rates

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