Billing code 53260: Lesion destructionMedicare rate & RVUs

Medicare pays $213.77 for 53260 nationally in the office and $165.67 in a hospital or facility. Local office rates run $192.58–$263.14.

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

What 53260 covers

Code 53260 describes destruction of a simple lesion arising in the urethra, such as a condyloma or papilloma. A urologist typically performs the treatment in an office or facility setting. The code fits a limited treatment; extensive urethral lesion destruction belongs to the corresponding extensive service, while surgical removal of lesion tissue is a different service.

Select the code from the procedure performed and documented, including the lesion’s urethral location, extent, and treatment method. The procedure has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed 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 for this code. Medicare does not pay an assistant at surgery, and 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 53260 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

53260 rates by state

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

How the 53260 rate is calculated

Each of 53260’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 53260

53260 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

53260 compared with similar codes

How to choose

53265Urethral treatment

Both describe urethral lesion destruction. Choose 53260 for simple treatment and 53265 when the destruction is extensive.

53230Lesion excision

53230 is for surgical excision of a urethral lesion; 53260 is for destroying a simple lesion rather than removing it.

53220Urethral lesion treatment

53220 is specific to treatment of a urethral caruncle. Code 53260 addresses simple destruction of other urethral lesions.

Codes related to 53260

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