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Billing code 51900: Fistula repairMedicare rate & RVUs

Reports vaginal-route surgical closure of a communication between the bladder and vagina, commonly performed for persistent urinary leakage through the vagina.

CMS RVU26DEffective Oct 1, 2026109 payment localities32 Medicare services in 2024

Medicare pays $745.17 for 51900 nationally in a facility.

Medicare rate · 51900

Fistula repair

Work RVUs
14.26
Total RVUs
22.31
Global days
090

National rate · 2026

$745.17

Facility setting, before claim adjustments.

See every locality for 51900 →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 51900 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 51900 covers

This operation closes a vesicovaginal fistula through the vagina. The surgeon identifies and separates the bladder and vaginal sides of the abnormal opening, then closes the defect. It is commonly performed by a urologist, urogynecologist, or gynecologic surgeon when a patient has ongoing urine leakage into the vagina, often after pelvic surgery or an obstetric injury. The service is generally performed in an operating room rather than an office setting.

Report 51900 when the documented fistula is between the bladder and vagina and the repair uses the vaginal route. The operative report should support the fistula location, the approach, and the closure performed; an uncomplicated vaginal injury without a bladder fistula is a different service. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% 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 51900 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

51900 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$692.68
Alaska*Unavailable$969.38
ArizonaUnavailable$729.93
ArkansasUnavailable$686.24
AtlantaUnavailable$762.21
AustinUnavailable$751.21
BakersfieldUnavailable$750.27
Baltimore/Surr. CntysUnavailable$782.45
BeaumontUnavailable$722.14
BrazoriaUnavailable$733.67

51900 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
51900 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 51900 rate is calculated

Each of 51900’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 · 51900

RVUs × geographic indexes × conversion factor

Work14.26

14.26 RVUs× 1.000 GPCI

Practice expense6.22

6.22 RVUs× 1.000 GPCI

Malpractice1.83

1.83 RVUs× 1.000 GPCI

Adjusted RVUs

22.3100

Conversion factor

$33.4009

Medicare rate

$745.17

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

Payment rules and modifiers for 51900

51900 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 51900

Fistula repair

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 · 51900

Fistula repair

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 51 · payment effect

With and without the modifier

51900 without 51 · national facility

$745.17

Fistula repair

51900-51 · Second procedure: 50%

$372.59

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

51900 compared with similar codes

Compare codes · National

4 codes, side by side

  • 51900

    Fistula repair14.26 wRVU

    Not priced

  • 51925

    Fistula repair17.09 wRVU

    Not priced

  • 51920

    Fistula repair13.07 wRVU

    Not priced

  • 57200

    Vaginal repair4.31 wRVU

    Not priced

How to choose

51925Fistula repair
Both codes address vesicovaginal fistula closure. Choose 51900 for the vaginal route and 51925 for the abdominal route, with or without hysterectomy.
51920Fistula repair
This code concerns a fistula between the bladder and uterus. Code 51900 is for a bladder-to-vagina communication.
57200Vaginal repair
This code is for repair of a nonobstetrical vaginal injury. Use 51900 when the operation closes a vesicovaginal fistula, not an isolated vaginal injury.

Codes related to 51900

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

Codes related to 51900
CodeHow it relatesNational office range
Same family
51925Fistula repairVesicovaginal fistula closure through an abdominal approach, with or without hysterectomy.No office rate
51920Fistula repairClosure of a vesicouterine fistula, involving the bladder and uterus rather than the vagina.No office rate
Used instead
51999Unlisted laps px bladderUnlisted laparoscopic bladder procedure code when no listed code describes the laparoscopic service.No office rate

51900 billing questions

When should 51900 be selected instead of 51925?

Use 51900 for closure of a vesicovaginal fistula through the vaginal route. Code 51925 describes the abdominal approach and includes the possibility of hysterectomy.

Is a vaginal laceration repair reported with 51900?

Not when there is no communication between the bladder and vagina. A nonobstetrical vaginal injury repair is a different service; the operative findings should establish whether a fistula was repaired.

Can modifier 50 be used for a fistula on each side?

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

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care. Separate procedures during the same session are subject to the standard multiple-procedure reduction.

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.

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 51900PPRRVU2026_Oct_nonQPP.csv, line 6,096 (RVU26D)

Open CMS sourceHow we calculate rates

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