$150.15–$207.03
53200 is for biopsy of the urethra to obtain tissue; 53265 is for treating a lesion.
On this page
CMS RVU26D · Effective 2026-10-01
53265 Urethral treatment Medicare reimbursement rates
Reports treatment directed at a urethral lesion, rather than diagnostic sampling alone or a separately described lesion-removal procedure. Compare 53265 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 53265?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$208.10–$285.59
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $77.49 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 53265 pays more and less
109 payment localities
$208.10 to $285.59
Urology procedure
About 53265: Urethral lesion treatment
Reports treatment directed at a urethral lesion, rather than diagnostic sampling alone or a separately described lesion-removal procedure.
CPT 53265 represents treatment directed at a lesion of the urethra. A urologist may perform the service in an office or facility after identifying a lesion during evaluation of urethral symptoms or endoscopic assessment. The note should identify the lesion’s location and describe the treatment performed. The code label alone does not establish that the lesion is a caruncle, polyp, or another specific type, so the documented service must support this code rather than a more specifically described procedure.
The code has a 10-day global period, which includes related postoperative visits during that period. 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 multiple procedure 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. Documentation should support the urethral site, the lesion treated, and the service performed.
CMS billing rules for 53265
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.09 · 45%
- Practice expense (office) RVU3.38 · 49%
- Malpractice RVU0.46 · 7%
1.1K
Medicare services in 2024 · #2919 by national volume
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.
53265 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
Both carry a CMS short descriptor for urethral-lesion treatment. Confirm the full CPT descriptor and the documented service when distinguishing them.
No office rate
53230 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.
No office rate
53235 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.
See how rates vary across the country
53265 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$208.10
$283.51
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $283.51 | 1 |
| AL | $210.69 | 1 |
| AR | $208.10 | 1 |
| AZ | $225.76 | 1 |
| CA | $236.93–$285.59 | 29 |
| CO | $236.57 | 1 |
| CT | $245.45 | 1 |
| DC | $258.87 | 1 |
| DE | $229.08 | 1 |
| FL | $234.23–$259.59 | 3 |
| GA | $222.23–$236.67 | 2 |
| GU | $240.47 | 1 |
| HI | $240.47 | 1 |
| IA | $212.61 | 1 |
| ID | $214.34 | 1 |
| IL | $230.30–$252.65 | 4 |
| IN | $215.33 | 1 |
| KS | $213.01 | 1 |
| KY | $217.63 | 1 |
| LA | $217.84–$226.90 | 2 |
| MA | $235.98–$255.91 | 2 |
| MD | $232.60–$258.87 | 3 |
| ME | $216.63–$224.78 | 2 |
| MI | $223.63–$238.06 | 2 |
| MN | $223.93 | 1 |
| MO | $215.49–$226.08 | 3 |
| MS | $211.77 | 1 |
| MT | $231.44 | 1 |
| NC | $218.36 | 1 |
| ND | $222.34 | 1 |
| NE | $213.22 | 1 |
| NH | $234.18 | 1 |
| NJ | $247.47–$257.08 | 2 |
| NM | $225.19 | 1 |
| NV | $229.02 | 1 |
| NY | $221.26–$272.58 | 5 |
| OH | $221.77 | 1 |
| OK | $215.96 | 1 |
| OR | $226.45–$241.72 | 2 |
| PA | $221.37–$240.92 | 2 |
| PR | $232.48 | 1 |
| RI | $235.50 | 1 |
| SC | $220.58 | 1 |
| SD | $221.27 | 1 |
| TN | $214.08 | 1 |
| TX | $220.22–$237.28 | 8 |
| UT | $223.13 | 1 |
| VA | $225.03–$258.87 | 2 |
| VI | $232.48 | 1 |
| VT | $222.75 | 1 |
| WA | $235.12–$259.44 | 2 |
| WI | $216.09 | 1 |
| WV | $223.30 | 1 |
| WY | $227.47 | 1 |
Compare 53265 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $210.69 | Facility $157.21 |
| Alaska* | Office $283.51 | Facility $218.42 |
| Arizona | Office $225.76 | Facility $166.53 |
| Arkansas | Office $208.10 | Facility $155.59 |
| Atlanta | Office $236.67 | Facility $174.57 |
| Austin | Office $236.47 | Facility $171.80 |
| Bakersfield | Office $238.26 | Facility $171.27 |
| Baltimore/Surr. Cntys | Office $245.00 | Facility $179.42 |
| Beaumont | Office $220.22 | Facility $164.59 |
| Brazoria | Office $227.90 | Facility $167.32 |
| Chicago | Office $252.65 | Facility $191.22 |
| Chico | Office $236.93 | Facility $169.94 |
| Colorado | Office $236.57 | Facility $171.53 |
| Connecticut | Office $245.45 | Facility $179.62 |
| Dallas | Office $229.76 | Facility $168.88 |
| Dc + Md/Va Suburbs | Office $258.87 | Facility $186.87 |
| Delaware | Office $229.08 | Facility $168.69 |
| Detroit | Office $238.06 | Facility $179.07 |
| East St. Louis | Office $238.02 | Facility $181.78 |
| El Centro | Office $237.01 | Facility $170.02 |
| Fort Lauderdale | Office $245.35 | Facility $183.43 |
| Fort Worth | Office $228.83 | Facility $168.57 |
| Fresno | Office $236.93 | Facility $169.94 |
| Galveston | Office $228.86 | Facility $168.17 |
| Hanford-Corcoran | Office $236.93 | Facility $169.94 |
| Hawaii, Guam | Office $240.47 | Facility $170.97 |
| Houston | Office $237.28 | Facility $176.58 |
| Idaho | Office $214.34 | Facility $158.11 |
| Indiana | Office $215.33 | Facility $158.67 |
| Iowa | Office $212.61 | Facility $156.68 |
| Kansas | Office $213.01 | Facility $157.75 |
| Kentucky | Office $217.63 | Facility $163.29 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $251.20 | Facility $178.89 |
| Madera | Office $236.93 | Facility $169.94 |
| Manhattan | Office $265.37 | Facility $194.34 |
| Merced | Office $236.93 | Facility $169.94 |
| Metropolitan Boston | Office $255.91 | Facility $182.93 |
| Metropolitan Kansas City | Office $224.23 | Facility $166.83 |
| Metropolitan Philadelphia | Office $240.92 | Facility $177.29 |
| Metropolitan St. Louis | Office $226.08 | Facility $167.89 |
| Miami | Office $259.59 | Facility $195.96 |
| Minnesota | Office $223.93 | Facility $161.03 |
| Mississippi | Office $211.77 | Facility $159.14 |
| Modesto | Office $236.93 | Facility $169.94 |
| Montana** | Office $231.44 | Facility $170.31 |
| Napa | Office $266.31 | Facility $185.75 |
| Nebraska | Office $213.22 | Facility $156.80 |
| Nevada** | Office $229.02 | Facility $167.83 |
| New Hampshire | Office $234.18 | Facility $170.55 |
| New Mexico | Office $225.19 | Facility $169.14 |
| New Orleans | Office $226.90 | Facility $169.38 |
| North Carolina | Office $218.36 | Facility $161.33 |
| North Dakota** | Office $222.34 | Facility $161.22 |
| Northern Nj | Office $257.08 | Facility $186.17 |
| Nyc Suburbs/Long Island | Office $272.58 | Facility $199.90 |
| Ohio | Office $221.77 | Facility $165.96 |
| Oklahoma | Office $215.96 | Facility $161.38 |
| Oxnard-Thousand Oaks-Ventura | Office $249.11 | Facility $176.86 |
| Portland | Office $241.72 | Facility $173.81 |
| Poughkpsie/N Nyc Suburbs | Office $250.06 | Facility $183.13 |
| Puerto Rico | Office $232.48 | Facility $170.68 |
| Queens | Office $265.41 | Facility $193.16 |
| Redding | Office $236.93 | Facility $169.94 |
| Rest Of California | Office $236.93 | Facility $169.94 |
| Rest Of Florida | Office $234.23 | Facility $175.79 |
| Rest Of Georgia | Office $222.23 | Facility $167.70 |
| Rest Of Illinois | Office $230.30 | Facility $174.49 |
| Rest Of Louisiana | Office $217.84 | Facility $163.75 |
| Rest Of Maine | Office $216.63 | Facility $160.40 |
| Rest Of Maryland | Office $232.60 | Facility $170.74 |
| Rest Of Massachusetts | Office $235.98 | Facility $171.62 |
| Rest Of Michigan | Office $223.63 | Facility $167.82 |
| Rest Of Missouri | Office $215.49 | Facility $162.80 |
| Rest Of New Jersey | Office $247.47 | Facility $180.73 |
| Rest Of New York | Office $221.26 | Facility $163.19 |
| Rest Of Oregon | Office $226.45 | Facility $165.57 |
| Rest Of Pennsylvania | Office $221.37 | Facility $165.25 |
| Rest Of Texas | Office $224.22 | Facility $166.21 |
| Rest Of Washington | Office $235.12 | Facility $170.76 |
| Rhode Island | Office $235.50 | Facility $172.35 |
| Riverside-San Bernardino-Ontario | Office $241.91 | Facility $174.91 |
| Sacramento-Roseville-Folsom | Office $246.46 | Facility $175.37 |
| Salinas | Office $245.49 | Facility $174.65 |
| San Diego-Chula Vista-Carlsbad | Office $249.66 | Facility $176.55 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $279.25 | Facility $193.06 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $278.73 | Facility $192.54 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $285.59 | Facility $197.45 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $283.46 | Facility $195.32 |
| San Luis Obispo-Paso Robles | Office $241.79 | Facility $172.17 |
| Santa Cruz-Watsonville | Office $250.78 | Facility $176.51 |
| Santa Maria-Santa Barbara | Office $245.97 | Facility $174.70 |
| Santa Rosa-Petaluma | Office $253.18 | Facility $178.12 |
| Seattle (King Cnty) | Office $259.44 | Facility $184.45 |
| South Carolina | Office $220.58 | Facility $164.11 |
| South Dakota** | Office $221.27 | Facility $160.14 |
| Southern Maine | Office $224.78 | Facility $164.21 |
| Stockton | Office $236.93 | Facility $169.94 |
| Suburban Chicago | Office $247.10 | Facility $184.33 |
| Tennessee | Office $214.08 | Facility $158.52 |
| Utah | Office $223.13 | Facility $165.67 |
| Vallejo | Office $265.56 | Facility $185.00 |
| Vermont | Office $222.75 | Facility $162.24 |
| Virgin Islands | Office $232.48 | Facility $170.68 |
| Virginia | Office $225.03 | Facility $164.95 |
| Visalia | Office $236.93 | Facility $169.94 |
| West Virginia | Office $223.30 | Facility $170.18 |
| Wisconsin | Office $216.09 | Facility $157.54 |
| Wyoming** | Office $227.47 | Facility $166.35 |
| Yuba City | Office $236.93 | Facility $169.94 |
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53265 billing questions
When should 53265 be chosen instead of a urethral biopsy code?
Use 53265 for treatment of the lesion. Use 53200 when the service is a biopsy to obtain tissue for diagnosis.
How does 53265 differ from urethral lesion-removal codes?
53265 describes treatment of a urethral lesion. Codes 53230 and 53235 describe removal of a urethral lesion; report the code that matches the documented procedure.
Are related postoperative visits separately included?
Related postoperative visits during the 10-day global period are included in 53265.
Can modifier 50 be used for treatment on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 53265. Co-surgeons and team surgery are not permitted.
What happens if another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,18553240,,Surgery for urethra pouch,A,,6.90,3.95,NA,3.95,,0.89,11.74,11.74,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18653250,,Removal of urethra gland,A,,6.36,3.82,NA,3.82,,0.82,11.00,11.00,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18753260,,Treatment of urethra lesion,A,,2.95,3.02,,1.58,,0.43,6.40,4.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18853265,,Treatment of urethra lesion,A,,3.09,3.38,,1.55,,0.46,6.93,5.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18953270,,Removal of urethra gland,A,,3.06,3.10,,1.61,,0.40,6.56,5.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19053275,,Repair of urethra defect,A,,4.46,2.06,NA,2.06,,0.62,7.14,7.14,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19153400,,Revise urethra stage 1,A,,13.78,6.06,NA,6.06,,1.83,21.67,21.67,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00