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Billing code 50520: Fistula closureMedicare rate & RVUs

Reports surgical closure of an abnormal tract connecting the kidney to the skin, such as a persistent nephrocutaneous fistula.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,095.22 for 50520 nationally in a facility.

Medicare rate · 50520

Fistula closure

Swap in your local Medicare rate.

Work RVUs
18.41
Total RVUs
32.79
Global days
090

National rate · 2026

$1,095.22

Facility setting, before claim adjustments.

See every locality for 50520 → · 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 50520 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 50520 covers

This service closes a fistulous tract between the kidney and the skin. A urologist typically performs the operation in a surgical setting when a persistent connection requires operative closure, including a tract that remains after nephrostomy drainage. The surgeon addresses the tract and its openings as needed to eliminate the abnormal communication.

Report 50520 when the documented connection is specifically between kidney and skin; the destination of the tract distinguishes it from closure of a fistula to a viscus. The operative report should establish the kidney-to-skin communication and describe its surgical closure. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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 50520 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

50520 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$984.50
Alaska*Unavailable$1,349.60
ArizonaUnavailable$1,061.79
ArkansasUnavailable$971.08
AtlantaUnavailable$1,135.08
AustinUnavailable$1,096.10
BakersfieldUnavailable$1,073.14
Baltimore/Surr. CntysUnavailable$1,167.01
BeaumontUnavailable$1,055.10
BrazoriaUnavailable$1,061.21

50520 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
50520 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 50520 rate is calculated

Each of 50520’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 · 50520

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 18.41Practice expense 9.47Malpractice 4.91

32.7900 adjusted RVUs×$33.4009 conversion factor=$1,095.22

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 50520

50520 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 50520

Fistula closure

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)0The 150% bilateral adjustment doesn’t apply.
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 · 50520

Fistula closure

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 51 · payment effect

With and without the modifier

50520 without 51 · national facility

$1,095.22

Fistula closure

50520-51 · Second procedure: 50%

$547.61

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%).

When to use modifier 51

50520 compared with similar codes

Compare codes

50520 vs 50525 vs 50526 vs 50500: national Medicare rates

Swap in your local Medicare rate.

  • 50520
    Fistula closure · 18.41 wRVU
    —
  • 50525
    Fistula closure · 23.78 wRVU
    —
  • 50526
    Fistula closure · 25.65 wRVU
    —
  • 50500
    Kidney repair · 20.69 wRVU
    —

How to choose

50525Fistula closure
This code addresses a fistula involving a viscus. Choose 50520 when the documented tract connects the kidney to the skin.
50526Fistula closure
This code is also for nephrovisceral fistula closure. The kidney-to-skin connection identifies 50520 instead.
50500Kidney repair
50500 is for repair of a kidney wound. Use 50520 when the operation closes a fistulous tract from the kidney to the skin.

Codes related to 50520

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

Codes related to 50520
CodeHow it relatesNational office range
Same family
50525Fistula closureClosure of a nephrovisceral fistula, rather than a kidney-to-skin fistula.No office rate
50526Fistula closureA nephrovisceral fistula closure code; distinguish by the fistula's destination.No office rate

50520 billing questions

When should 50520 be selected instead of 50525 or 50526?

Use 50520 for a fistulous connection between the kidney and skin. Codes 50525 and 50526 concern nephrovisceral fistulas, where the connection is to a viscus.

What documentation supports reporting 50520?

The record should identify the kidney-to-skin fistula and describe the operative closure. A skin opening or drainage alone does not establish that connection.

Can modifier 50 be used for bilateral closure?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

How does the 90-day global period affect postoperative care?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant or co-surgeon be reported?

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

What happens when another procedure is performed in the same session?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.

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 50520PPRRVU2026_Oct_nonQPP.csv, line 5,927 (RVU26D)

Open CMS sourceHow we calculate rates

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