Billing code 53200: Urethral biopsyMedicare rate & RVUs

Medicare pays $166.00 for 53200 nationally in the office and $127.93 in a hospital or facility. Local office rates run $150.15–$207.03.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 53200 covers

A urologist samples tissue from a urethral abnormality when examination raises concern for a condition that requires histologic evaluation. The service may be performed in an office procedure setting or a facility, with the approach guided by the location and visibility of the abnormal tissue. The specimen is sent for pathology; the code represents diagnostic tissue sampling rather than treatment that removes or destroys the lesion.

Report the service when the operative or procedure note identifies the urethral site sampled and supports that tissue was obtained for diagnosis. Distinguish urethral sampling from cystourethroscopic biopsy directed to the bladder, and from therapeutic treatment or excision of a urethral lesion. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment are 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 53200 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

53200 rates by state

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

How the 53200 rate is calculated

Each of 53200’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.

Payment rules and modifiers for 53200

The CMS indicators that decide how 53200 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

53200 compared with similar codes

How to choose

52204Cystoscopic biopsy

Use this code for sampling urethral tissue. Code 52204 describes biopsy during cystourethroscopy and is commonly associated with a bladder biopsy; identify the actual target and procedure in the record.

53220Urethral lesion treatment

This code is for diagnostic tissue sampling. Code 53220 represents treatment of a urethral lesion, so select it when the service is therapeutic rather than obtaining tissue for diagnosis.

53230Lesion excision

This code represents sampling for diagnosis; 53230 represents removal of a urethral lesion. Report the removal service when the lesion is excised rather than merely sampled.

Codes related to 53200

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

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

Open CMS sourceHow we calculate rates