FeeBase
Log inGet started
Menu

Billing code 53420: Urethral reconstructionMedicare rate & RVUs

Reports the initial operation in a planned two-stage urethral reconstruction, typically for a urethral stricture or defect requiring staged repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities15 Medicare services in 2024

Medicare pays $757.53 for 53420 nationally in a facility.

Medicare rate · 53420

Urethral reconstruction

Swap in your local Medicare rate.

Work RVUs
14.79
Total RVUs
22.68
Global days
090

National rate · 2026

$757.53

Facility setting, before claim adjustments.

See every locality for 53420 → · 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 53420 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 53420 covers

A urologist or reconstructive urologist performs the first operation in a planned two-stage urethral repair. In a Johanson-type approach, the diseased segment is opened and the urethral bed is prepared to heal before a later operation completes the reconstruction. This staged approach may be selected for complex urethral narrowing or tissue deficiency when immediate tubular reconstruction is not appropriate. The service is generally performed in a hospital or other surgical facility.

Report 53420 for the initial reconstructive operation, not the later completion stage. The operative report should establish the urethral problem, the staged plan, the work performed at this operation, and any tissue used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care 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. Assistant-at-surgery payment is restricted; 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 53420 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

53420 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$704.88
Alaska*Unavailable$988.87
ArizonaUnavailable$742.15
ArkansasUnavailable$698.43
AtlantaUnavailable$775.03
AustinUnavailable$762.83
BakersfieldUnavailable$761.15
Baltimore/Surr. CntysUnavailable$795.14
BeaumontUnavailable$735.03
BrazoriaUnavailable$745.65

53420 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
53420 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 53420 rate is calculated

Each of 53420’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 · 53420

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 14.79Practice expense 5.98Malpractice 1.91

22.6800 adjusted RVUs×$33.4009 conversion factor=$757.53

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

Payment rules and modifiers for 53420

53420 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 53420

Urethral reconstruction

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)1Not paid (statutory restriction).
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 · 53420

Urethral reconstruction

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

53420 without 51 · national facility

$757.53

Urethral reconstruction

53420-51 · Second procedure: 50%

$378.77

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

53420 compared with similar codes

Compare codes

53420 vs 53425 vs 53400 vs 53405: national Medicare rates

Swap in your local Medicare rate.

  • 53420
    Urethral reconstruction · 14.79 wRVU
    —
  • 53425
    Urethral reconstruction · 16.64 wRVU
    —
  • 53400
    Urethral repair · 13.78 wRVU
    —
  • 53405
    Urethroplasty · 15.27 wRVU
    —

How to choose

53425Urethral reconstruction
Use 53420 for the initial operation in the planned staged repair; use 53425 for its second-stage completion.
53400Urethral repair
53400 is for a one-stage urethral reconstruction. Choose 53420 when the operative plan divides reconstruction into stages and this is the first operation.
53405Urethroplasty
53405 describes a staged urethral revision, while 53420 is for staged urethral reconstruction; the operative purpose distinguishes them.

Codes related to 53420

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

Codes related to 53420
CodeHow it relatesNational office range
Same family
53425Urethral reconstructionReports the second stage of the staged urethral reconstruction.No office rate
Used instead
53400Urethral repairA one-stage urethral reconstruction may fit when the repair is completed in one operation.No office rate
53405UrethroplastyA staged urethral revision code for a revision rather than the reconstruction reported with 53420.No office rate

53420 billing questions

How is 53420 different from 53425?

53420 represents the initial operation in the planned staged reconstruction. 53425 represents the later second-stage operation.

When would a single-stage urethral reconstruction code be considered instead?

Consider a single-stage code, such as 53400, when the surgeon completes the reconstruction in one operation rather than documenting a planned two-stage repair.

What documentation supports reporting 53420?

Document the urethral stricture or defect, why reconstruction is staged, the first-stage work performed, and the plan for the later stage.

Can modifier 50 be reported?

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

How does the global period affect postoperative billing?

The 90-day global includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

Can an assistant or co-surgeon be billed?

CMS restricts assistant-at-surgery payment. 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 53420PPRRVU2026_Oct_nonQPP.csv, line 6,195 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 53420 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 53420 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →