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Billing code 50525: Fistula closureMedicare rate & RVUs

Reports surgical closure of an abnormal connection between a kidney and an internal organ, such as bowel, when the fistula is repaired.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,378.79 for 50525 nationally in a facility.

Medicare rate · 50525

Fistula closure

Swap in your local Medicare rate.

Work RVUs
23.78
Total RVUs
41.28
Global days
090

National rate · 2026

$1,378.79

Facility setting, before claim adjustments.

See every locality for 50525 → · 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 50525 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 50525 covers

This operation closes an abnormal tract connecting the kidney to an internal organ, such as the colon. A urologist typically performs the renal portion of the repair; another surgeon may participate when the connected organ also requires operative management. The operative report should identify the kidney, the connected viscus, and the repair performed. This code distinguishes a kidney-to-viscus fistula from a tract that drains to the skin.

Report the service when the surgeon repairs the nephrovisceral connection. If the closure is performed with partial nephrectomy, compare the operative work with 50526. CMS assigns a 90-day global period, including 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 others are subject to the standard 50% multiple-procedure 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.

Where 50525 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

50525 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,240.08
Alaska*Unavailable$1,704.73
ArizonaUnavailable$1,336.66
ArkansasUnavailable$1,223.30
AtlantaUnavailable$1,429.82
AustinUnavailable$1,377.74
BakersfieldUnavailable$1,346.54
Baltimore/Surr. CntysUnavailable$1,469.01
BeaumontUnavailable$1,330.22
BrazoriaUnavailable$1,335.06

50525 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
50525 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 50525 rate is calculated

Each of 50525’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 · 50525

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 23.78Practice expense 11.14Malpractice 6.36

41.2800 adjusted RVUs×$33.4009 conversion factor=$1,378.79

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

Payment rules and modifiers for 50525

50525 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 50525

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 · 50525

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

50525 without 51 · national facility

$1,378.79

Fistula closure

50525-51 · Second procedure: 50%

$689.40

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

50525 compared with similar codes

Compare codes

50525 vs 50520 vs 50526 vs 50500: national Medicare rates

Swap in your local Medicare rate.

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

How to choose

50520Fistula closure
Use 50525 for a connection from the kidney to an internal organ; 50520 describes a connection from the kidney to the skin.
50526Fistula closure
50526 is the related code when fistula closure is performed with partial nephrectomy; use 50525 when that additional renal resection is not performed.
50500Kidney repair
50500 addresses repair of a kidney wound. It is not the fistula-closure code for an abnormal connection between the kidney and an internal organ.

Codes related to 50525

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

Codes related to 50525
CodeHow it relatesNational office range
Same family
50520Fistula closureFistula-closure code for a kidney-to-skin connection rather than a connection to an internal organ.No office rate
50526Fistula closureRelated nephrovisceral fistula code for closure performed with partial nephrectomy.No office rate
50500Kidney repairRelated renal repair code for a kidney wound, not a kidney-to-viscus fistula.No office rate

50525 billing questions

How is this different from 50520?

50525 is for a fistula connecting the kidney to an internal organ. 50520 is for a kidney-to-skin fistula.

When should 50526 be considered instead?

Consider 50526 when the nephrovisceral fistula closure is performed with partial nephrectomy. The operative report should support the additional renal resection.

Can modifier 50 be reported for a bilateral repair?

No. CMS identifies bilateral adjustment as inappropriate for this code.

How does the multiple-procedure reduction affect payment?

For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.

Can an assistant or co-surgeon be reported?

An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

What postoperative care is included in the global period?

The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.

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 50525PPRRVU2026_Oct_nonQPP.csv, line 5,928 (RVU26D)

Open CMS sourceHow we calculate rates

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