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Billing code 53445: Artificial sphincterMedicare rate & RVUs

Reports surgical implantation of an inflatable urinary sphincter, including its cuff, pump, and reservoir, for selected patients with severe urinary incontinence.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.7K Medicare services in 2024

Medicare pays $689.39 for 53445 nationally in a facility.

Medicare rate · 53445

Artificial sphincter

Swap in your local Medicare rate.

Work RVUs
12.68
Total RVUs
20.64
Global days
090

National rate · 2026

$689.39

Facility setting, before claim adjustments.

See every locality for 53445 → · 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 53445 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 53445 covers

A urologist typically performs this operation in a hospital or ambulatory surgery setting for severe urinary incontinence caused by inadequate urethral sphincter closure. A common clinical situation is persistent stress incontinence after prostate surgery. The surgeon implants an inflatable system with a cuff around the urethra or bladder neck, a control pump, and a fluid reservoir; the patient operates the pump to allow urination.

Report this code for implantation of the sphincter system, not for later removal, replacement, repair, or adjustment. The operative report should identify the indication, device placement, and components implanted. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. Modifier 50 is inappropriate. 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 53445 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

53445 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$639.34
Alaska*Unavailable$890.45
ArizonaUnavailable$675.00
ArkansasUnavailable$633.18
AtlantaUnavailable$704.99
AustinUnavailable$696.30
BakersfieldUnavailable$696.45
Baltimore/Surr. CntysUnavailable$724.51
BeaumontUnavailable$666.50
BrazoriaUnavailable$678.90

53445 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
53445 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 53445 rate is calculated

Each of 53445’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 · 53445

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.68Practice expense 6.33Malpractice 1.63

20.6400 adjusted RVUs×$33.4009 conversion factor=$689.39

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

Payment rules and modifiers for 53445

53445 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 53445

Artificial sphincter

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 · 53445

Artificial sphincter

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

53445 without 51 · national facility

$689.39

Artificial sphincter

53445-51 · Second procedure: 50%

$344.70

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

53445 compared with similar codes

Compare codes

53445 vs 53444 vs 53440 vs 53447: national Medicare rates

Swap in your local Medicare rate.

  • 53445
    Artificial sphincter · 12.68 wRVU
    —
  • 53444
    Tandem cuff · 13.84 wRVU
    —
  • 53440
    Male sling · 13.03 wRVU
    —
  • 53447
    Sphincter replacement · 13.92 wRVU
    —

How to choose

53444Tandem cuff
53445 reports implantation of the sphincter system; 53444 reports an additional tandem cuff and is used as an add-on when that cuff is placed.
53440Male sling
53440 is for a male sling procedure. Choose 53445 when the surgeon implants an inflatable cuff, pump, and reservoir system.
53447Sphincter replacement
53447 applies when an existing urinary sphincter is removed and replaced. Use 53445 for implantation rather than removal and replacement of a prior device.

Codes related to 53445

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

Codes related to 53445
CodeHow it relatesNational office range
Add-on codes
53444Tandem cuffAdd-on code for placing a tandem cuff with sphincter implantation.No office rate
Used instead
53440Male slingMale sling surgery is a different operative approach for male stress incontinence.No office rate
Same family
53447Sphincter replacementAddresses removal and replacement of an existing urinary sphincter rather than initial implantation.No office rate

53445 billing questions

How is this different from the male sling code?

Report 53445 for implantation of an inflatable cuff-and-pump sphincter system. The male sling code 53440 describes a sling procedure, a different surgical approach to male stress incontinence.

Can a tandem cuff be reported with this implantation?

Code 53444 describes insertion of a tandem cuff and is an add-on to the sphincter implantation when that additional cuff is placed. The operative documentation should support the additional cuff.

Does this code include removal or replacement of an existing device?

No. Use the applicable removal, replacement, or component-replacement code when that is the service performed; 53445 describes implantation of the sphincter system.

Should modifier 50 be appended for bilateral work?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

What postoperative care is included?

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

How are other procedures in the same session paid?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Assistant-at-surgery payment may be available; 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 53445PPRRVU2026_Oct_nonQPP.csv, line 6,202 (RVU26D)

Open CMS sourceHow we calculate rates

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