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Billing code 51920: Fistula repairMedicare rate & RVUs

Reports operative closure of an abnormal connection between the bladder and uterus, such as a fistula following cesarean delivery or pelvic surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $692.73 for 51920 nationally in a facility.

Medicare rate · 51920

Fistula repair

Swap in your local Medicare rate.

Work RVUs
13.07
Total RVUs
20.74
Global days
090

National rate · 2026

$692.73

Facility setting, before claim adjustments.

See every locality for 51920 → · 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 51920 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 51920 covers

This code is for surgical closure of a vesicouterine fistula, an abnormal passage connecting the bladder and uterus. These fistulas may follow cesarean delivery or other pelvic surgery and can cause urine to pass through the uterus. A urologist or gynecologic surgeon may perform the repair in a hospital or other surgical setting. The operative report should establish that the communication is between the bladder and uterus and describe its closure.

Select this code for the vesicouterine fistula repair, rather than a repair directed at a bladder-vaginal fistula or a nonfistulous bladder defect. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. 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 51920 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

51920 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$643.37
Alaska*Unavailable$898.82
ArizonaUnavailable$678.45
ArkansasUnavailable$637.31
AtlantaUnavailable$708.52
AustinUnavailable$698.81
BakersfieldUnavailable$698.30
Baltimore/Surr. CntysUnavailable$727.62
BeaumontUnavailable$670.74
BrazoriaUnavailable$682.08

51920 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
51920 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 51920 rate is calculated

Each of 51920’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 · 51920

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 13.07Practice expense 5.99Malpractice 1.68

20.7400 adjusted RVUs×$33.4009 conversion factor=$692.73

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

Payment rules and modifiers for 51920

51920 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 51920

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 · 51920

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.

  • 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

51920 without 51 · national facility

$692.73

Fistula repair

51920-51 · Second procedure: 50%

$346.37

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

51920 compared with similar codes

Compare codes

51920 vs 51900 vs 51925 vs 51940: national Medicare rates

Swap in your local Medicare rate.

  • 51920
    Fistula repair · 13.07 wRVU
    —
  • 51900
    Fistula repair · 14.26 wRVU
    —
  • 51925
    Fistula repair · 17.09 wRVU
    —
  • 51940
    Bladder repair · 29.89 wRVU
    —

How to choose

51900Fistula repair
This code addresses a bladder-to-uterus fistula. Code 51900 is for a bladder-to-vagina fistula repaired through a vaginal approach.
51925Fistula repair
Code 51925 describes bladder-vaginal fistula repair with hysterectomy. Use this code for a bladder-to-uterus fistula, based on the documented anatomy and operation.
51940Bladder repair
Code 51940 concerns correction of a bladder defect, not closure of a fistulous connection between the bladder and uterus.

Codes related to 51920

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

Codes related to 51920
CodeHow it relatesNational office range
Same family
51900Fistula repairFistula-closure code for a bladder-to-vagina connection approached vaginally.No office rate
51925Fistula repairRelated bladder-vaginal fistula repair code that includes hysterectomy.No office rate

51920 billing questions

How is this different from a vesicovaginal fistula repair?

Use this code when the fistula connects the bladder and uterus. A bladder-to-vagina fistula is a different anatomic repair; the approach and any accompanying procedure also matter when selecting its code.

Does this code include a hysterectomy?

The code identifies closure of a vesicouterine fistula. Document any hysterectomy separately as a distinct performed service and select its code based on the actual operation.

Can modifier 50 be used?

No. Bilateral adjustment is inappropriate for this code’s descriptor and anatomy.

What documentation supports reporting this code?

The operative report should identify the bladder-to-uterus fistula and describe the surgical closure. Include the clinical context, such as a fistula following pelvic surgery, when documented.

How are other procedures in the same session paid?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the session are subject to reduction. Related postoperative care is included in this code’s 90-day global period.

May an assistant or co-surgeon be reported?

An assistant at surgery 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 51920PPRRVU2026_Oct_nonQPP.csv, line 6,097 (RVU26D)

Open CMS sourceHow we calculate rates

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