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CMS RVU26D · Effective 2026-10-01

53265 in Redding

Office / nonfacility

$236.93

Base rate per service

Facility setting

$169.94

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 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 rates for Redding, from the same CMS release.

53200

Urethral biopsy

Diagnostic tissue sampling

$168.16

53200 is for biopsy of the urethra to obtain tissue; 53265 is for treating a lesion.

53220

Urethral lesion treatment

Caruncle

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.

53230

Lesion excision

Complicated excision

No office rate

53230 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.

53235

Urethral excision

Female urethral lesion

No office rate

53235 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.

The same code, a different location

How does Redding compare?

In Bakersfield, the office rate for 53265 is $238.26—$1.33 higher than the $236.93 rate in Redding. Both use the same code, release and participation basis.

53265 across payment areas

Same release and payment basis · bars start at $0

  1. Redding · This locality

    $236.93

  2. Bakersfield

    $238.26

    $1.33 higher than Redding

  3. Chico

    $236.93

    The same base rate than Redding

  4. El Centro

    $237.01

    $0.08 higher than Redding

  5. Fresno

    $236.93

    The same base rate than Redding

  6. Hanford-Corcoran

    $236.93

    The same base rate than Redding

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

    $251.20

    $14.27 higher than Redding

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, 53265 ranges from $208.10 in Arkansas to $285.59 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). 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 · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Merced

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Modesto

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Napa

    California · 53265

    Office

    $266.31

    Facility

    $185.75

    $29.38 higher than Redding for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 53265

    Office

    $249.11

    Facility

    $176.86

    $12.18 higher than Redding for the office setting.

  • Rest Of California

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 53265

    Office

    $241.91

    Facility

    $174.91

    $4.98 higher than Redding for the office setting.

  • Sacramento-Roseville-Folsom

    California · 53265

    Office

    $246.46

    Facility

    $175.37

    $9.53 higher than Redding for the office setting.

  • Salinas

    California · 53265

    Office

    $245.49

    Facility

    $174.65

    $8.56 higher than Redding for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 53265

    Office

    $249.66

    Facility

    $176.55

    $12.73 higher than Redding for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 53265

    Office

    $279.25

    Facility

    $193.06

    $42.32 higher than Redding for the office setting.

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

    California · 53265

    Office

    $278.73

    Facility

    $192.54

    $41.80 higher than Redding for the office setting.

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

    California · 53265

    Office

    $285.59

    Facility

    $197.45

    $48.66 higher than Redding for the office setting.

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

    California · 53265

    Office

    $283.46

    Facility

    $195.32

    $46.53 higher than Redding for the office setting.

  • San Luis Obispo-Paso Robles

    California · 53265

    Office

    $241.79

    Facility

    $172.17

    $4.86 higher than Redding for the office setting.

  • Santa Cruz-Watsonville

    California · 53265

    Office

    $250.78

    Facility

    $176.51

    $13.85 higher than Redding for the office setting.

  • Santa Maria-Santa Barbara

    California · 53265

    Office

    $245.97

    Facility

    $174.70

    $9.04 higher than Redding for the office setting.

  • Santa Rosa-Petaluma

    California · 53265

    Office

    $253.18

    Facility

    $178.12

    $16.25 higher than Redding for the office setting.

  • Stockton

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Vallejo

    California · 53265

    Office

    $265.56

    Facility

    $185.00

    $28.63 higher than Redding for the office setting.

  • Visalia

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Yuba City

    California · 53265

    Office

    $236.93

    Facility

    $169.94

    The same base rate than Redding for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 53265

    Office

    $258.87

    Facility

    $186.87

    $21.94 higher than Redding for the office setting.

  • Miami

    Florida · 53265

    Office

    $259.59

    Facility

    $195.96

    $22.66 higher than Redding for the office setting.

  • Chicago

    Illinois · 53265

    Office

    $252.65

    Facility

    $191.22

    $15.72 higher than Redding for the office setting.

  • Manhattan

    New York · 53265

    Office

    $265.37

    Facility

    $194.34

    $28.44 higher than Redding for the office setting.

  • Alaska*

    Alaska · 53265

    Office

    $283.51

    Facility

    $218.42

    $46.58 higher than Redding for the office setting.

  • Alabama

    Alabama · 53265

    Office

    $210.69

    Facility

    $157.21

    $26.24 lower than Redding for the office setting.

  • Arkansas

    Arkansas · 53265

    Office

    $208.10

    Facility

    $155.59

    $28.83 lower than Redding for the office setting.

  • Arizona

    Arizona · 53265

    Office

    $225.76

    Facility

    $166.53

    $11.17 lower than Redding for the office setting.

  • Colorado

    Colorado · 53265

    Office

    $236.57

    Facility

    $171.53

    $0.36 lower than Redding for the office setting.

  • Connecticut

    Connecticut · 53265

    Office

    $245.45

    Facility

    $179.62

    $8.52 higher than Redding for the office setting.

  • Delaware

    Delaware · 53265

    Office

    $229.08

    Facility

    $168.69

    $7.85 lower than Redding for the office setting.

  • Fort Lauderdale

    Florida · 53265

    Office

    $245.35

    Facility

    $183.43

    $8.42 higher than Redding for the office setting.

  • Rest Of Florida

    Florida · 53265

    Office

    $234.23

    Facility

    $175.79

    $2.70 lower than Redding for the office setting.

  • Atlanta

    Georgia · 53265

    Office

    $236.67

    Facility

    $174.57

    $0.26 lower than Redding for the office setting.

  • Rest Of Georgia

    Georgia · 53265

    Office

    $222.23

    Facility

    $167.70

    $14.70 lower than Redding for the office setting.

  • Hawaii, Guam

    Hawaii · 53265

    Office

    $240.47

    Facility

    $170.97

    $3.54 higher than Redding for the office setting.

  • Iowa

    Iowa · 53265

    Office

    $212.61

    Facility

    $156.68

    $24.32 lower than Redding for the office setting.

  • Idaho

    Idaho · 53265

    Office

    $214.34

    Facility

    $158.11

    $22.59 lower than Redding for the office setting.

  • East St. Louis

    Illinois · 53265

    Office

    $238.02

    Facility

    $181.78

    $1.09 higher than Redding for the office setting.

  • Rest Of Illinois

    Illinois · 53265

    Office

    $230.30

    Facility

    $174.49

    $6.63 lower than Redding for the office setting.

  • Suburban Chicago

    Illinois · 53265

    Office

    $247.10

    Facility

    $184.33

    $10.17 higher than Redding for the office setting.

  • Indiana

    Indiana · 53265

    Office

    $215.33

    Facility

    $158.67

    $21.60 lower than Redding for the office setting.

  • Kansas

    Kansas · 53265

    Office

    $213.01

    Facility

    $157.75

    $23.92 lower than Redding for the office setting.

  • Kentucky

    Kentucky · 53265

    Office

    $217.63

    Facility

    $163.29

    $19.30 lower than Redding for the office setting.

  • New Orleans

    Louisiana · 53265

    Office

    $226.90

    Facility

    $169.38

    $10.03 lower than Redding for the office setting.

  • Rest Of Louisiana

    Louisiana · 53265

    Office

    $217.84

    Facility

    $163.75

    $19.09 lower than Redding for the office setting.

  • Metropolitan Boston

    Massachusetts · 53265

    Office

    $255.91

    Facility

    $182.93

    $18.98 higher than Redding for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 53265

    Office

    $235.98

    Facility

    $171.62

    $0.95 lower than Redding for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 53265

    Office

    $245.00

    Facility

    $179.42

    $8.07 higher than Redding for the office setting.

  • Rest Of Maryland

    Maryland · 53265

    Office

    $232.60

    Facility

    $170.74

    $4.33 lower than Redding for the office setting.

  • Rest Of Maine

    Maine · 53265

    Office

    $216.63

    Facility

    $160.40

    $20.30 lower than Redding for the office setting.

  • Southern Maine

    Maine · 53265

    Office

    $224.78

    Facility

    $164.21

    $12.15 lower than Redding for the office setting.

  • Detroit

    Michigan · 53265

    Office

    $238.06

    Facility

    $179.07

    $1.13 higher than Redding for the office setting.

  • Rest Of Michigan

    Michigan · 53265

    Office

    $223.63

    Facility

    $167.82

    $13.30 lower than Redding for the office setting.

  • Minnesota

    Minnesota · 53265

    Office

    $223.93

    Facility

    $161.03

    $13.00 lower than Redding for the office setting.

  • Metropolitan Kansas City

    Missouri · 53265

    Office

    $224.23

    Facility

    $166.83

    $12.70 lower than Redding for the office setting.

  • Metropolitan St. Louis

    Missouri · 53265

    Office

    $226.08

    Facility

    $167.89

    $10.85 lower than Redding for the office setting.

  • Rest Of Missouri

    Missouri · 53265

    Office

    $215.49

    Facility

    $162.80

    $21.44 lower than Redding for the office setting.

  • Mississippi

    Mississippi · 53265

    Office

    $211.77

    Facility

    $159.14

    $25.16 lower than Redding for the office setting.

  • Montana**

    Montana · 53265

    Office

    $231.44

    Facility

    $170.31

    $5.49 lower than Redding for the office setting.

  • North Carolina

    North Carolina · 53265

    Office

    $218.36

    Facility

    $161.33

    $18.57 lower than Redding for the office setting.

  • North Dakota**

    North Dakota · 53265

    Office

    $222.34

    Facility

    $161.22

    $14.59 lower than Redding for the office setting.

  • Nebraska

    Nebraska · 53265

    Office

    $213.22

    Facility

    $156.80

    $23.71 lower than Redding for the office setting.

  • New Hampshire

    New Hampshire · 53265

    Office

    $234.18

    Facility

    $170.55

    $2.75 lower than Redding for the office setting.

  • Northern Nj

    New Jersey · 53265

    Office

    $257.08

    Facility

    $186.17

    $20.15 higher than Redding for the office setting.

  • Rest Of New Jersey

    New Jersey · 53265

    Office

    $247.47

    Facility

    $180.73

    $10.54 higher than Redding for the office setting.

  • New Mexico

    New Mexico · 53265

    Office

    $225.19

    Facility

    $169.14

    $11.74 lower than Redding for the office setting.

  • Nevada**

    Nevada · 53265

    Office

    $229.02

    Facility

    $167.83

    $7.91 lower than Redding for the office setting.

  • Nyc Suburbs/Long Island

    New York · 53265

    Office

    $272.58

    Facility

    $199.90

    $35.65 higher than Redding for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 53265

    Office

    $250.06

    Facility

    $183.13

    $13.13 higher than Redding for the office setting.

  • Queens

    New York · 53265

    Office

    $265.41

    Facility

    $193.16

    $28.48 higher than Redding for the office setting.

  • Rest Of New York

    New York · 53265

    Office

    $221.26

    Facility

    $163.19

    $15.67 lower than Redding for the office setting.

  • Ohio

    Ohio · 53265

    Office

    $221.77

    Facility

    $165.96

    $15.16 lower than Redding for the office setting.

  • Oklahoma

    Oklahoma · 53265

    Office

    $215.96

    Facility

    $161.38

    $20.97 lower than Redding for the office setting.

  • Portland

    Oregon · 53265

    Office

    $241.72

    Facility

    $173.81

    $4.79 higher than Redding for the office setting.

  • Rest Of Oregon

    Oregon · 53265

    Office

    $226.45

    Facility

    $165.57

    $10.48 lower than Redding for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 53265

    Office

    $240.92

    Facility

    $177.29

    $3.99 higher than Redding for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 53265

    Office

    $221.37

    Facility

    $165.25

    $15.56 lower than Redding for the office setting.

  • Puerto Rico

    Puerto Rico · 53265

    Office

    $232.48

    Facility

    $170.68

    $4.45 lower than Redding for the office setting.

  • Rhode Island

    Rhode Island · 53265

    Office

    $235.50

    Facility

    $172.35

    $1.43 lower than Redding for the office setting.

  • South Carolina

    South Carolina · 53265

    Office

    $220.58

    Facility

    $164.11

    $16.35 lower than Redding for the office setting.

  • South Dakota**

    South Dakota · 53265

    Office

    $221.27

    Facility

    $160.14

    $15.66 lower than Redding for the office setting.

  • Tennessee

    Tennessee · 53265

    Office

    $214.08

    Facility

    $158.52

    $22.85 lower than Redding for the office setting.

  • Austin

    Texas · 53265

    Office

    $236.47

    Facility

    $171.80

    $0.46 lower than Redding for the office setting.

  • Beaumont

    Texas · 53265

    Office

    $220.22

    Facility

    $164.59

    $16.71 lower than Redding for the office setting.

  • Brazoria

    Texas · 53265

    Office

    $227.90

    Facility

    $167.32

    $9.03 lower than Redding for the office setting.

  • Dallas

    Texas · 53265

    Office

    $229.76

    Facility

    $168.88

    $7.17 lower than Redding for the office setting.

  • Fort Worth

    Texas · 53265

    Office

    $228.83

    Facility

    $168.57

    $8.10 lower than Redding for the office setting.

  • Galveston

    Texas · 53265

    Office

    $228.86

    Facility

    $168.17

    $8.07 lower than Redding for the office setting.

  • Houston

    Texas · 53265

    Office

    $237.28

    Facility

    $176.58

    $0.35 higher than Redding for the office setting.

  • Rest Of Texas

    Texas · 53265

    Office

    $224.22

    Facility

    $166.21

    $12.71 lower than Redding for the office setting.

  • Utah

    Utah · 53265

    Office

    $223.13

    Facility

    $165.67

    $13.80 lower than Redding for the office setting.

  • Virginia

    Virginia · 53265

    Office

    $225.03

    Facility

    $164.95

    $11.90 lower than Redding for the office setting.

  • Virgin Islands

    United States Virgin Islands · 53265

    Office

    $232.48

    Facility

    $170.68

    $4.45 lower than Redding for the office setting.

  • Vermont

    Vermont · 53265

    Office

    $222.75

    Facility

    $162.24

    $14.18 lower than Redding for the office setting.

  • Rest Of Washington

    Washington · 53265

    Office

    $235.12

    Facility

    $170.76

    $1.81 lower than Redding for the office setting.

  • Seattle (King Cnty)

    Washington · 53265

    Office

    $259.44

    Facility

    $184.45

    $22.51 higher than Redding for the office setting.

  • Wisconsin

    Wisconsin · 53265

    Office

    $216.09

    Facility

    $157.54

    $20.84 lower than Redding for the office setting.

  • West Virginia

    West Virginia · 53265

    Office

    $223.30

    Facility

    $170.18

    $13.63 lower than Redding for the office setting.

  • Wyoming**

    Wyoming · 53265

    Office

    $227.47

    Facility

    $166.35

    $9.46 lower than Redding for the office setting.

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.

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.

$208.10

$283.51

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$283.511
AL$210.691
AR$208.101
AZ$225.761
CA$236.93–$285.5929
CO$236.571
CT$245.451
DC$258.871
DE$229.081
FL$234.23–$259.593
GA$222.23–$236.672
GU$240.471
HI$240.471
IA$212.611
ID$214.341
IL$230.30–$252.654
IN$215.331
KS$213.011
KY$217.631
LA$217.84–$226.902
MA$235.98–$255.912
MD$232.60–$258.873
ME$216.63–$224.782
MI$223.63–$238.062
MN$223.931
MO$215.49–$226.083
MS$211.771
MT$231.441
NC$218.361
ND$222.341
NE$213.221
NH$234.181
NJ$247.47–$257.082
NM$225.191
NV$229.021
NY$221.26–$272.585
OH$221.771
OK$215.961
OR$226.45–$241.722
PA$221.37–$240.922
PR$232.481
RI$235.501
SC$220.581
SD$221.271
TN$214.081
TX$220.22–$237.288
UT$223.131
VA$225.03–$258.872
VI$232.481
VT$222.751
WA$235.12–$259.442
WI$216.091
WV$223.301
WY$227.471

Explore 53265 on the national rate map →

Where does this rate apply?

Redding is a Medicare payment area. Our Census mapping connects it to 32 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 53265 in Redding, the physician’s office rate is $236.93 and the facility-setting rate is $169.94: a difference of $66.99.

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 53265 in Redding. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$260.62

$236.93 × 110% = $260.62

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 53265 in Redding.

PPRRVU2026_Oct_nonQPP.csv

6,188

Code
53265
Physician work
3.09
Practice expense
3.38
Malpractice
0.46

GPCI2026.csv

19

Locality
Redding
Physician work
1.017
Practice expense
1.096
Malpractice
0.536
Office / nonfacility calculation for 53265 in Redding
ComponentRVULocality factorAdjusted
Physician work3.09× 1.0173.1425
Practice expense3.38× 1.0963.7045
Malpractice0.46× 0.5360.2466
Total RVUs7.0936
Conversion factor× 33.4009

Office / nonfacility rate, Redding$236.93

Open 53265 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.091.017
Practice expense3.381.096
Malpractice0.460.536

(3.09 × 1.017 + 3.38 × 1.096 + 0.46 × 0.536) × $33.4009 = $236.93

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.091.017
Practice expense1.551.096
Malpractice0.460.536

(3.09 × 1.017 + 1.55 × 1.096 + 0.46 × 0.536) × $33.4009 = $169.94

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

53265 · Office / nonfacility

$236.93

Effective 2026-10-01

The base rate is $7.94 higher than on 2025-10-01, moving from $228.99 to $236.93 (3.5%).

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

    $228.99changed to$236.93

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.17 changed to 3.09
    • Practice expense RVU 3.29 changed to 3.38
    • Malpractice RVU 0.48 changed to 0.46
    • 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: $228.99

    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$236.93$169.94RVU26D
2026-07-01$236.93$169.94RVU26C
2026-04-01$236.93$169.94RVU26B
2026-01-01$236.93$169.94RVU26A
2025-10-01$228.99$186.21RVU25D
2025-07-01$228.99$186.21RVU25C
2025-04-01$228.99$186.21RVU25B
2025-01-01$228.99$186.21RVU25A

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.

RVUs for 53265PPRRVU2026_Oct_nonQPP.csv, line 6,188 (RVU26D)
Geographic factors for ReddingGPCI2026.csv, line 19 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet