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CMS RVU26D · Effective 2026-10-01

53200 in Modesto

Office / nonfacility

$168.16

Base rate per service

Facility setting

$126.42

Base rate per service

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.

Urology procedure

About 53200: Urethral tissue biopsy

Reports targeted sampling of urethral tissue for diagnostic evaluation of a suspicious mucosal abnormality or lesion.

A urologist samples tissue from a urethral abnormality when examination raises concern for a condition that requires histologic evaluation. The service may be performed in an office procedure setting or a facility, with the approach guided by the location and visibility of the abnormal tissue. The specimen is sent for pathology; the code represents diagnostic tissue sampling rather than treatment that removes or destroys the lesion.

Report the service when the operative or procedure note identifies the urethral site sampled and supports that tissue was obtained for diagnosis. Distinguish urethral sampling from cystourethroscopic biopsy directed to the bladder, and from therapeutic treatment or excision of a urethral lesion. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. 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 50% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment are not permitted.

CMS billing rules for 53200

Global period
Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU2.53 · 51%
  • Practice expense (office) RVU2.06 · 41%
  • Malpractice RVU0.38 · 8%

273

Medicare services in 2024 · #4067 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.

53200 compared with similar codes

Office rates for Modesto, from the same CMS release.

52204

Cystoscopic biopsy

Bladder tissue sampling

$376.47

Use this code for sampling urethral tissue. Code 52204 describes biopsy during cystourethroscopy and is commonly associated with a bladder biopsy; identify the actual target and procedure in the record.

53220

Urethral lesion treatment

Caruncle

No office rate

This code is for diagnostic tissue sampling. Code 53220 represents treatment of a urethral lesion, so select it when the service is therapeutic rather than obtaining tissue for diagnosis.

53230

Lesion excision

Complicated excision

No office rate

This code represents sampling for diagnosis; 53230 represents removal of a urethral lesion. Report the removal service when the lesion is excised rather than merely sampled.

The same code, a different location

How does Modesto compare?

In Bakersfield, the office rate for 53200 is $169.25—$1.09 higher than the $168.16 rate in Modesto. Both use the same code, release and participation basis.

53200 across payment areas

Same release and payment basis · bars start at $0

  1. Modesto · This locality

    $168.16

  2. Bakersfield

    $169.25

    $1.09 higher than Modesto

  3. Chico

    $168.16

    The same base rate than Modesto

  4. El Centro

    $168.22

    $0.06 higher than Modesto

  5. Fresno

    $168.16

    The same base rate than Modesto

  6. Hanford-Corcoran

    $168.16

    The same base rate than Modesto

  7. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $177.79

    $9.63 higher than Modesto

Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 53200 ranges from $150.15 in Arkansas to $207.03 in Alaska*. This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Madera

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Merced

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Napa

    California · 53200

    Office

    $186.96

    Facility

    $136.78

    $18.80 higher than Modesto for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 53200

    Office

    $176.11

    Facility

    $131.10

    $7.95 higher than Modesto for the office setting.

  • Redding

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Rest Of California

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 53200

    Office

    $172.26

    Facility

    $130.53

    $4.10 higher than Modesto for the office setting.

  • Sacramento-Roseville-Folsom

    California · 53200

    Office

    $174.37

    Facility

    $130.09

    $6.21 higher than Modesto for the office setting.

  • Salinas

    California · 53200

    Office

    $173.67

    Facility

    $129.54

    $5.51 higher than Modesto for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 53200

    Office

    $176.21

    Facility

    $130.67

    $8.05 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 53200

    Office

    $195.37

    Facility

    $141.69

    $27.21 higher than Modesto for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 53200

    Office

    $194.94

    Facility

    $141.25

    $26.78 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 53200

    Office

    $199.82

    Facility

    $144.91

    $31.66 higher than Modesto for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 53200

    Office

    $198.06

    Facility

    $143.15

    $29.90 higher than Modesto for the office setting.

  • San Luis Obispo-Paso Robles

    California · 53200

    Office

    $171.11

    Facility

    $127.74

    $2.95 higher than Modesto for the office setting.

  • Santa Cruz-Watsonville

    California · 53200

    Office

    $176.68

    Facility

    $130.42

    $8.52 higher than Modesto for the office setting.

  • Santa Maria-Santa Barbara

    California · 53200

    Office

    $173.90

    Facility

    $129.50

    $5.74 higher than Modesto for the office setting.

  • Santa Rosa-Petaluma

    California · 53200

    Office

    $178.34

    Facility

    $131.58

    $10.18 higher than Modesto for the office setting.

  • Stockton

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Vallejo

    California · 53200

    Office

    $186.34

    Facility

    $136.15

    $18.18 higher than Modesto for the office setting.

  • Visalia

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Yuba City

    California · 53200

    Office

    $168.16

    Facility

    $126.42

    The same base rate than Modesto for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 53200

    Office

    $184.25

    Facility

    $139.39

    $16.09 higher than Modesto for the office setting.

  • Miami

    Florida · 53200

    Office

    $188.23

    Facility

    $148.59

    $20.07 higher than Modesto for the office setting.

  • Chicago

    Illinois · 53200

    Office

    $183.37

    Facility

    $145.11

    $15.21 higher than Modesto for the office setting.

  • Manhattan

    New York · 53200

    Office

    $190.00

    Facility

    $145.75

    $21.84 higher than Modesto for the office setting.

  • Alaska*

    Alaska · 53200

    Office

    $207.03

    Facility

    $166.48

    $38.87 higher than Modesto for the office setting.

  • Alabama

    Alabama · 53200

    Office

    $151.89

    Facility

    $118.58

    $16.27 lower than Modesto for the office setting.

  • Arkansas

    Arkansas · 53200

    Office

    $150.15

    Facility

    $117.44

    $18.01 lower than Modesto for the office setting.

  • Arizona

    Arizona · 53200

    Office

    $162.04

    Facility

    $125.15

    $6.12 lower than Modesto for the office setting.

  • Colorado

    Colorado · 53200

    Office

    $168.64

    Facility

    $128.13

    $0.48 higher than Modesto for the office setting.

  • Connecticut

    Connecticut · 53200

    Office

    $175.66

    Facility

    $134.65

    $7.50 higher than Modesto for the office setting.

  • Delaware

    Delaware · 53200

    Office

    $164.32

    Facility

    $126.70

    $3.84 lower than Modesto for the office setting.

  • Fort Lauderdale

    Florida · 53200

    Office

    $177.15

    Facility

    $138.58

    $8.99 higher than Modesto for the office setting.

  • Rest Of Florida

    Florida · 53200

    Office

    $169.36

    Facility

    $132.96

    $1.20 higher than Modesto for the office setting.

  • Atlanta

    Georgia · 53200

    Office

    $169.91

    Facility

    $131.22

    $1.75 higher than Modesto for the office setting.

  • Rest Of Georgia

    Georgia · 53200

    Office

    $161.01

    Facility

    $127.04

    $7.15 lower than Modesto for the office setting.

  • Hawaii, Guam

    Hawaii · 53200

    Office

    $170.09

    Facility

    $126.79

    $1.93 higher than Modesto for the office setting.

  • Iowa

    Iowa · 53200

    Office

    $152.50

    Facility

    $117.66

    $15.66 lower than Modesto for the office setting.

  • Idaho

    Idaho · 53200

    Office

    $153.81

    Facility

    $118.78

    $14.35 lower than Modesto for the office setting.

  • East St. Louis

    Illinois · 53200

    Office

    $173.37

    Facility

    $138.34

    $5.21 higher than Modesto for the office setting.

  • Rest Of Illinois

    Illinois · 53200

    Office

    $167.16

    Facility

    $132.40

    $1.00 lower than Modesto for the office setting.

  • Suburban Chicago

    Illinois · 53200

    Office

    $178.25

    Facility

    $139.15

    $10.09 higher than Modesto for the office setting.

  • Indiana

    Indiana · 53200

    Office

    $154.46

    Facility

    $119.16

    $13.70 lower than Modesto for the office setting.

  • Kansas

    Kansas · 53200

    Office

    $153.10

    Facility

    $118.68

    $15.06 lower than Modesto for the office setting.

  • Kentucky

    Kentucky · 53200

    Office

    $157.29

    Facility

    $123.44

    $10.87 lower than Modesto for the office setting.

  • New Orleans

    Louisiana · 53200

    Office

    $163.67

    Facility

    $127.84

    $4.49 lower than Modesto for the office setting.

  • Rest Of Louisiana

    Louisiana · 53200

    Office

    $157.56

    Facility

    $123.86

    $10.60 lower than Modesto for the office setting.

  • Metropolitan Boston

    Massachusetts · 53200

    Office

    $181.42

    Facility

    $135.96

    $13.26 higher than Modesto for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 53200

    Office

    $168.42

    Facility

    $128.33

    $0.26 higher than Modesto for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 53200

    Office

    $175.39

    Facility

    $134.53

    $7.23 higher than Modesto for the office setting.

  • Rest Of Maryland

    Maryland · 53200

    Office

    $166.63

    Facility

    $128.10

    $1.53 lower than Modesto for the office setting.

  • Rest Of Maine

    Maine · 53200

    Office

    $155.70

    Facility

    $120.67

    $12.46 lower than Modesto for the office setting.

  • Southern Maine

    Maine · 53200

    Office

    $160.70

    Facility

    $122.97

    $7.46 lower than Modesto for the office setting.

  • Detroit

    Michigan · 53200

    Office

    $172.30

    Facility

    $135.56

    $4.14 higher than Modesto for the office setting.

  • Rest Of Michigan

    Michigan · 53200

    Office

    $161.65

    Facility

    $126.89

    $6.51 lower than Modesto for the office setting.

  • Minnesota

    Minnesota · 53200

    Office

    $159.06

    Facility

    $119.88

    $9.10 lower than Modesto for the office setting.

  • Metropolitan Kansas City

    Missouri · 53200

    Office

    $161.51

    Facility

    $125.76

    $6.65 lower than Modesto for the office setting.

  • Metropolitan St. Louis

    Missouri · 53200

    Office

    $162.73

    Facility

    $126.48

    $5.43 lower than Modesto for the office setting.

  • Rest Of Missouri

    Missouri · 53200

    Office

    $156.18

    Facility

    $123.35

    $11.98 lower than Modesto for the office setting.

  • Mississippi

    Mississippi · 53200

    Office

    $153.13

    Facility

    $120.34

    $15.03 lower than Modesto for the office setting.

  • Montana**

    Montana · 53200

    Office

    $165.98

    Facility

    $127.90

    $2.18 lower than Modesto for the office setting.

  • North Carolina

    North Carolina · 53200

    Office

    $156.81

    Facility

    $121.28

    $11.35 lower than Modesto for the office setting.

  • North Dakota**

    North Dakota · 53200

    Office

    $158.46

    Facility

    $120.39

    $9.70 lower than Modesto for the office setting.

  • Nebraska

    Nebraska · 53200

    Office

    $152.81

    Facility

    $117.66

    $15.35 lower than Modesto for the office setting.

  • New Hampshire

    New Hampshire · 53200

    Office

    $167.24

    Facility

    $127.60

    $0.92 lower than Modesto for the office setting.

  • Northern Nj

    New Jersey · 53200

    Office

    $183.20

    Facility

    $139.03

    $15.04 higher than Modesto for the office setting.

  • Rest Of New Jersey

    New Jersey · 53200

    Office

    $176.94

    Facility

    $135.36

    $8.78 higher than Modesto for the office setting.

  • New Mexico

    New Mexico · 53200

    Office

    $162.84

    Facility

    $127.93

    $5.32 lower than Modesto for the office setting.

  • Nevada**

    Nevada · 53200

    Office

    $163.95

    Facility

    $125.84

    $4.21 lower than Modesto for the office setting.

  • Nyc Suburbs/Long Island

    New York · 53200

    Office

    $195.29

    Facility

    $150.02

    $27.13 higher than Modesto for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 53200

    Office

    $179.01

    Facility

    $137.31

    $10.85 higher than Modesto for the office setting.

  • Queens

    New York · 53200

    Office

    $189.54

    Facility

    $144.54

    $21.38 higher than Modesto for the office setting.

  • Rest Of New York

    New York · 53200

    Office

    $158.79

    Facility

    $122.62

    $9.37 lower than Modesto for the office setting.

  • Ohio

    Ohio · 53200

    Office

    $160.12

    Facility

    $125.35

    $8.04 lower than Modesto for the office setting.

  • Oklahoma

    Oklahoma · 53200

    Office

    $155.81

    Facility

    $121.81

    $12.35 lower than Modesto for the office setting.

  • Portland

    Oregon · 53200

    Office

    $171.74

    Facility

    $129.44

    $3.58 higher than Modesto for the office setting.

  • Rest Of Oregon

    Oregon · 53200

    Office

    $161.96

    Facility

    $124.03

    $6.20 lower than Modesto for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 53200

    Office

    $172.79

    Facility

    $133.16

    $4.63 higher than Modesto for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 53200

    Office

    $159.66

    Facility

    $124.71

    $8.50 lower than Modesto for the office setting.

  • Puerto Rico

    Puerto Rico · 53200

    Office

    $166.57

    Facility

    $128.07

    $1.59 lower than Modesto for the office setting.

  • Rhode Island

    Rhode Island · 53200

    Office

    $168.51

    Facility

    $129.17

    $0.35 higher than Modesto for the office setting.

  • South Carolina

    South Carolina · 53200

    Office

    $158.87

    Facility

    $123.69

    $9.29 lower than Modesto for the office setting.

  • South Dakota**

    South Dakota · 53200

    Office

    $157.57

    Facility

    $119.50

    $10.59 lower than Modesto for the office setting.

  • Tennessee

    Tennessee · 53200

    Office

    $153.86

    Facility

    $119.25

    $14.30 lower than Modesto for the office setting.

  • Austin

    Texas · 53200

    Office

    $168.72

    Facility

    $128.43

    $0.56 higher than Modesto for the office setting.

  • Beaumont

    Texas · 53200

    Office

    $158.91

    Facility

    $124.26

    $9.25 lower than Modesto for the office setting.

  • Brazoria

    Texas · 53200

    Office

    $163.27

    Facility

    $125.53

    $4.89 lower than Modesto for the office setting.

  • Dallas

    Texas · 53200

    Office

    $164.69

    Facility

    $126.76

    $3.47 lower than Modesto for the office setting.

  • Fort Worth

    Texas · 53200

    Office

    $164.16

    Facility

    $126.62

    $4.00 lower than Modesto for the office setting.

  • Galveston

    Texas · 53200

    Office

    $164.01

    Facility

    $126.20

    $4.15 lower than Modesto for the office setting.

  • Houston

    Texas · 53200

    Office

    $170.97

    Facility

    $133.16

    $2.81 higher than Modesto for the office setting.

  • Rest Of Texas

    Texas · 53200

    Office

    $161.26

    Facility

    $125.13

    $6.90 lower than Modesto for the office setting.

  • Utah

    Utah · 53200

    Office

    $160.58

    Facility

    $124.79

    $7.58 lower than Modesto for the office setting.

  • Virginia

    Virginia · 53200

    Office

    $161.10

    Facility

    $123.67

    $7.06 lower than Modesto for the office setting.

  • Virgin Islands

    United States Virgin Islands · 53200

    Office

    $166.57

    Facility

    $128.07

    $1.59 lower than Modesto for the office setting.

  • Vermont

    Vermont · 53200

    Office

    $159.04

    Facility

    $121.35

    $9.12 lower than Modesto for the office setting.

  • Rest Of Washington

    Washington · 53200

    Office

    $167.71

    Facility

    $127.62

    $0.45 lower than Modesto for the office setting.

  • Seattle (King Cnty)

    Washington · 53200

    Office

    $183.52

    Facility

    $136.80

    $15.36 higher than Modesto for the office setting.

  • Wisconsin

    Wisconsin · 53200

    Office

    $154.33

    Facility

    $117.85

    $13.83 lower than Modesto for the office setting.

  • West Virginia

    West Virginia · 53200

    Office

    $162.46

    Facility

    $129.37

    $5.70 lower than Modesto for the office setting.

  • Wyoming**

    Wyoming · 53200

    Office

    $162.70

    Facility

    $124.63

    $5.46 lower than Modesto for the office setting.

See how rates vary across the country

53200 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

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.

$150.15

$207.03

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$207.031
AL$151.891
AR$150.151
AZ$162.041
CA$168.16–$199.8229
CO$168.641
CT$175.661
DC$184.251
DE$164.321
FL$169.36–$188.233
GA$161.01–$169.912
GU$170.091
HI$170.091
IA$152.501
ID$153.811
IL$167.16–$183.374
IN$154.461
KS$153.101
KY$157.291
LA$157.56–$163.672
MA$168.42–$181.422
MD$166.63–$184.253
ME$155.70–$160.702
MI$161.65–$172.302
MN$159.061
MO$156.18–$162.733
MS$153.131
MT$165.981
NC$156.811
ND$158.461
NE$152.811
NH$167.241
NJ$176.94–$183.202
NM$162.841
NV$163.951
NY$158.79–$195.295
OH$160.121
OK$155.811
OR$161.96–$171.742
PA$159.66–$172.792
PR$166.571
RI$168.511
SC$158.871
SD$157.571
TN$153.861
TX$158.91–$170.978
UT$160.581
VA$161.10–$184.252
VI$166.571
VT$159.041
WA$167.71–$183.522
WI$154.331
WV$162.461
WY$162.701

Explore 53200 on the national rate map →

Where does this rate apply?

Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in California →

Why are the office and facility amounts different?

For 53200 in Modesto, the physician’s office rate is $168.16 and the facility-setting rate is $126.42: a difference of $41.74.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 53200 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$184.98

$168.16 × 110% = $184.98

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 53200 in Modesto.

PPRRVU2026_Oct_nonQPP.csv

6,179

Code
53200
Physician work
2.53
Practice expense
2.06
Malpractice
0.38

GPCI2026.csv

16

Locality
Modesto
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 53200 in Modesto
ComponentRVULocality factorAdjusted
Physician work2.53× 1.0172.5730
Practice expense2.06× 1.0962.2578
Malpractice0.38× 0.5360.2037
Total RVUs5.0344
Conversion factor× 33.4009

Office / nonfacility rate, Modesto$168.16

Open 53200 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work2.531.017
Practice expense2.061.096
Malpractice0.380.536

(2.53 × 1.017 + 2.06 × 1.096 + 0.38 × 0.536) × $33.4009 = $168.16

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work2.531.017
Practice expense0.921.096
Malpractice0.380.536

(2.53 × 1.017 + 0.92 × 1.096 + 0.38 × 0.536) × $33.4009 = $126.42

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

53200 · Office / nonfacility

$168.16

Effective 2026-10-01

The base rate is $10.40 higher than on 2025-10-01, moving from $157.76 to $168.16 (6.6%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $157.76changed to$168.16

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.59 changed to 2.53
    • Practice expense RVU 1.88 changed to 2.06
    • Malpractice RVU 0.35 changed to 0.38
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.560 changed to 0.536

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $157.76

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$168.16$126.42RVU26D
2026-07-01$168.16$126.42RVU26C
2026-04-01$168.16$126.42RVU26B
2026-01-01$168.16$126.42RVU26A
2025-10-01$157.76$137.96RVU25D
2025-07-01$157.76$137.96RVU25C
2025-04-01$157.76$137.96RVU25B
2025-01-01$157.76$137.96RVU25A

53200 billing questions

How does this differ from 52204?

This code represents sampling of urethral tissue. Code 52204 describes biopsy work performed during cystourethroscopy, commonly for a bladder target; document the actual biopsy site and procedure.

Can this be reported with treatment of the same urethral lesion?

A diagnostic sample and a therapeutic procedure are distinct services, but documentation must establish that both were performed and that the biopsy was not simply part of the treatment. Check applicable coding edits before reporting both.

Should modifier 50 be appended for sampling both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so do not use modifier 50.

What documentation supports reporting this service?

Record the urethral location, the abnormal tissue sampled, the diagnostic reason for sampling, and that tissue was obtained and submitted for examination.

How are other procedures in the same session paid?

CMS pays the highest-valued procedure in full and applies the standard 50% multiple-procedure reduction to the other procedures. Same-day preoperative and postoperative care is included in this code's 0-day global period.

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.

RVUs for 53200PPRRVU2026_Oct_nonQPP.csv, line 6,179 (RVU26D)
Geographic factors for ModestoGPCI2026.csv, line 16 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet