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Billing code 53220: Urethral lesion treatmentMedicare rate & RVUs

Reports surgical treatment of a urethral caruncle by excision or fulguration, typically performed by a urologist for a symptomatic lesion.

CMS RVU26DEffective Oct 1, 2026109 payment localities51 Medicare services in 2024

Medicare pays $415.84 for 53220 nationally in a facility.

Medicare rate · 53220

Urethral lesion treatment

Work RVUs
7.44
Total RVUs
12.45
Global days
090

National rate · 2026

$415.84

Facility setting, before claim adjustments.

See every locality for 53220 →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 53220 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 53220 covers

This code describes excision or fulguration of a urethral caruncle, a localized lesion at the urethral opening that may cause bleeding, irritation, or urinary symptoms. A urologist typically performs the procedure in a surgical or procedural setting. The operative approach depends on the lesion and the planned treatment; the record should identify the caruncle and document the technique performed.

Report the code for treatment of a caruncle, not merely diagnostic tissue sampling. The operative note should support the lesion treated and the work performed. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. 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 requires documented medical necessity; co-surgeons and team surgery 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 53220 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

53220 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$385.02
Alaska*Unavailable$534.49
ArizonaUnavailable$407.03
ArkansasUnavailable$381.22
AtlantaUnavailable$425.20
AustinUnavailable$420.53
BakersfieldUnavailable$421.01
Baltimore/Surr. CntysUnavailable$437.29
BeaumontUnavailable$401.39
BrazoriaUnavailable$409.56

53220 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
53220 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 53220 rate is calculated

Each of 53220’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 · 53220

RVUs × geographic indexes × conversion factor

Work7.44

7.44 RVUs× 1.000 GPCI

Practice expense4.05

4.05 RVUs× 1.000 GPCI

Malpractice0.96

0.96 RVUs× 1.000 GPCI

Adjusted RVUs

12.4500

Conversion factor

$33.4009

Medicare rate

$415.84

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

Payment rules and modifiers for 53220

53220 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 53220

Urethral lesion treatment

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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
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 · 53220

Urethral lesion treatment

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

53220 without 51 · national facility

$415.84

Urethral lesion treatment

53220-51 · Second procedure: 50%

$207.92

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

53220 compared with similar codes

Compare codes · National

4 codes, side by side

  • 53220

    Urethral lesion treatment7.44 wRVU

    Not priced

  • 53200

    Urethral biopsy2.53 wRVU

    $166.00

  • 53260

    Lesion destruction2.95 wRVU

    $213.77

  • 53265

    Urethral treatment3.09 wRVU

    $231.47

How to choose

53200Urethral biopsy
53200 reports urethral biopsy for diagnostic sampling. Use 53220 when the procedure treats a urethral caruncle by excision or fulguration.
53260Lesion destruction
53260 is used for treatment of a urethral lesion other than a caruncle. 53220 identifies treatment of a caruncle.
53265Urethral treatment
53265 is used for treatment of a urethral lesion other than a caruncle. 53220 identifies treatment of a caruncle.

Codes related to 53220

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

Codes related to 53220
CodeHow it relatesNational office range
Used instead
53200Urethral biopsyDiagnostic urethral tissue sampling rather than treatment of a caruncle.$150.15–$207.03
Same family
53260Lesion destructionUrethral lesion treatment code for a lesion other than a caruncle.$192.58–$263.14
53265Urethral treatmentUrethral lesion treatment code for a lesion other than a caruncle.$208.10–$285.59

53220 billing questions

When is 53220 appropriate instead of a urethral biopsy?

Use 53220 when the service treats a urethral caruncle by excision or fulguration. Code 53200 describes biopsy for diagnostic tissue sampling.

How does 53220 differ from 53260 or 53265?

53220 is for treatment of a urethral caruncle. Codes 53260 and 53265 address other urethral lesions, with the applicable code depending on the lesion and treatment extent.

Does the 90-day global include related postoperative care?

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

Can modifier 50 be reported for bilateral treatment?

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

When is an assistant-at-surgery payment allowed?

CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure 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 53220PPRRVU2026_Oct_nonQPP.csv, line 6,182 (RVU26D)

Open CMS sourceHow we calculate rates

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