FeeBase
Log inGet started
Menu

Billing code 53425: Urethral reconstructionMedicare rate & RVUs

Reports the second operation in a planned two-stage male urethral reconstruction, commonly completing a staged repair for hypospadias.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $839.70 for 53425 nationally in a facility.

Medicare rate · 53425

Urethral reconstruction

Swap in your local Medicare rate.

Work RVUs
16.64
Total RVUs
25.14
Global days
090

National rate · 2026

$839.70

Facility setting, before claim adjustments.

See every locality for 53425 → · 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 53425 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 53425 covers

This code represents the second operation in a planned two-stage male urethral reconstruction. The surgeon completes the urethral channel using tissue prepared during the first stage, often by tubularizing that tissue. A common context is staged repair of hypospadias or another urethral defect requiring reconstruction. A urologist or reconstructive surgeon typically performs the procedure in an operating room.

Report the code when the documented service is the second stage of the reconstruction, not the initial stage or a one-stage repair. The operative report should identify the staged plan, the prior first-stage work, and the reconstruction performed at this operation. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery payment may be available; 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 53425 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

53425 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$782.12
Alaska*Unavailable$1,099.31
ArizonaUnavailable$822.82
ArkansasUnavailable$775.08
AtlantaUnavailable$859.13
AustinUnavailable$844.98
BakersfieldUnavailable$842.70
Baltimore/Surr. CntysUnavailable$881.04
BeaumontUnavailable$815.51
BrazoriaUnavailable$826.51

53425 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
53425 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 53425 rate is calculated

Each of 53425’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 · 53425

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 16.64Practice expense 6.36Malpractice 2.14

25.1400 adjusted RVUs×$33.4009 conversion factor=$839.70

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

Payment rules and modifiers for 53425

53425 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 53425

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)2Paid.
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 · 53425

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

53425 without 51 · national facility

$839.70

Urethral reconstruction

53425-51 · Second procedure: 50%

$419.85

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

53425 compared with similar codes

Compare codes

53425 vs 53420 vs 53410 vs 53405: national Medicare rates

Swap in your local Medicare rate.

  • 53425
    Urethral reconstruction · 16.64 wRVU
    —
  • 53420
    Urethral reconstruction · 14.79 wRVU
    —
  • 53410
    Urethral reconstruction · 17.24 wRVU
    —
  • 53405
    Urethroplasty · 15.27 wRVU
    —

How to choose

53420Urethral reconstruction
53420 is for the first operation in a two-stage urethral reconstruction; 53425 is for the second operation that completes it.
53410Urethral reconstruction
53410 describes a one-stage male urethral reconstruction. Use 53425 when the reconstruction is performed as the second stage of a planned staged repair.
53405Urethroplasty
53405 is associated with staged urethroplasty for congenital or acquired urethral stricture; 53425 describes the second stage of urethral reconstruction, such as for hypospadias.

Codes related to 53425

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

Codes related to 53425
CodeHow it relatesNational office range
Same family
53420Urethral reconstructionFirst-stage code for a planned two-stage urethral reconstruction.No office rate
Used instead
53410Urethral reconstructionOne-stage male urethral reconstruction rather than a staged approach.No office rate
53405UrethroplastyStaged urethroplasty associated with congenital or acquired urethral stricture.No office rate

53425 billing questions

How is this code distinguished from 53420?

53420 reports the first stage of a two-stage urethral reconstruction. Use 53425 for the subsequent operation that completes the reconstruction.

Is 53425 the second stage for every staged urethroplasty?

No. This code is for staged urethral reconstruction, such as a hypospadias repair. Code 53405 is associated with staged urethroplasty for congenital or acquired urethral stricture.

Can 53425 be reported for a one-stage reconstruction?

No. A reconstruction performed as a single-stage procedure is represented by a different code, such as 53410 when its criteria are met.

What documentation supports reporting the second stage?

Document the planned two-stage reconstruction, the prior first-stage procedure, and the operative work that completes the urethral reconstruction.

How does the global period affect postoperative billing?

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

How are other procedures in the same session handled?

The highest-valued procedure is paid in full, with other procedures subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation.

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 53425PPRRVU2026_Oct_nonQPP.csv, line 6,196 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 53425 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 53425 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 →