No office rate
Use 53449 for operative repair of the urinary sphincter; use 53445 when inserting an artificial urinary sphincter.
On this page
CMS RVU26D · Effective 2026-10-01
53449 Sphincter repair Medicare reimbursement rates in Connecticut
Reports operative repair of the urinary sphincter, such as surgical correction of a sphincter defect causing urinary leakage. Compare 53449 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 53449 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$588.84
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology surgery
About 53449: Operative urinary sphincter repair
Reports operative repair of the urinary sphincter, such as surgical correction of a sphincter defect causing urinary leakage.
A urologist, often one specializing in reconstructive surgery, reports this service when an operation directly repairs the urinary sphincter. It is distinct from placing or exchanging an artificial urinary sphincter and from urethral reconstruction. The operative report should identify the sphincter defect and describe the repair performed; the service is generally provided in an operating-room setting.
Report the code when the documented work is sphincter repair, rather than device insertion, removal, or replacement. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53449
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.30 · 61%
- Practice expense (office) RVU5.12 · 31%
- Malpractice RVU1.33 · 8%
186
Medicare services in 2024 · #4383 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.
53449 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
Code 53447 describes removal and replacement of an artificial urinary sphincter. It is not the code for repairing the sphincter itself.
No office rate
Code 53448 covers removal and replacement of a urinary sphincter component; 53449 represents repair rather than component exchange.
Compare 53449 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
Unavailable
Facility
$588.84
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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 53449 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
6,206
- Code
- 53449
- Physician work
- 10.30
- Practice expense
- 5.12
- Malpractice
- 1.33
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.30 | × 1.020 | 10.5060 |
| Practice expense | 5.12 | × 1.077 | 5.5142 |
| Malpractice | 1.33 | × 1.210 | 1.6093 |
| Total RVUs | 17.6295 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$588.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.3 | 1.02 |
| Practice expense | 5.12 | 1.077 |
| Malpractice | 1.33 | 1.21 |
(10.3 × 1.02 + 5.12 × 1.077 + 1.33 × 1.21) × $33.4009 = $588.84
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.
53449 billing questions
How is this different from code 53445?
This code is for operative repair of the urinary sphincter. Code 53445 is for inserting an artificial urinary sphincter.
Can device replacement be reported as sphincter repair?
No. Removal and replacement of an artificial urinary sphincter or its component are represented by separate codes, including 53447 and 53448.
Should modifier 50 be used for repair on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting this code?
Document the urinary sphincter defect and the operative repair performed. The record should make clear that the service was repair, not device insertion, removal, or replacement.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure reduction.
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.
6,20353446,,Remove uro sphincter,A,,10.74,5.47,NA,5.47,,1.37,17.58,17.58,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20453447,,Remove/replace ur sphincter,A,,13.92,6.18,NA,6.18,,1.78,21.88,21.88,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20553448,,Remov/replc ur sphinctr comp,A,,22.85,8.43,NA,8.43,,2.94,34.22,34.22,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20653449,,Repair uro sphincter,A,,10.30,5.12,NA,5.12,,1.33,16.75,16.75,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20753450,,Revision of urethra,A,,6.60,3.89,NA,3.89,,0.86,11.35,11.35,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20853451,,Tprnl balo cntnc dev bi,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,010,0.10,0.80,0.10,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20953452,,Tprnl balo cntnc dev uni,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,010,0.10,0.80,0.10,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808