Billing code 54316: Urethral reconstructionMedicare rate & RVUs in Delaware
Reports the second operation in a planned two-stage reconstruction of the male anterior urethra, after the initial stage has prepared tissue for completion.
CMS doesn’t publish an office rate for 54316 in Delaware.
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 9 sections
What 54316 covers
This operation completes a planned two-stage reconstruction of the male anterior urethra. The urologist uses tissue prepared during the first stage to form or complete a urethral channel, commonly in a complex reconstruction after severe congenital abnormality or prior urethral surgery. It is performed in an operating room, with the operative report identifying the reconstructed segment and the work performed to complete the staged repair.
Report this code when the operative plan and documentation establish that this is the second stage of anterior urethral reconstruction, not a one-stage repair or the initial stage. Documentation should identify the prior first-stage work and the current reconstruction. CMS assigns a 90-day global period, including 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; 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.
54316 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $885.37 |
How the 54316 rate is calculated
Each of 54316’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 · 54316
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.60Practice expense 6.87Malpractice 2.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54316
54316 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54316
Urethral reconstruction
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 54316
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
54316 without 51 · national facility
$892.81
Urethral reconstruction
54316-51 · Second procedure: 50%
$446.41
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%).
54316 compared with similar codes
Compare codes
54316 vs 54312 vs 54308 vs 54324: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54312Urethral reconstruction
- 54312 is for the initial stage of the planned two-stage reconstruction; 54316 is for its completion.
- 54308Urethral reconstruction
- 54308 represents a one-stage anterior urethral reconstruction. Use 54316 when the documented operation is the second stage of a planned staged repair.
- 54324Hypospadias repair
- 54324 is a hypospadias repair code. Distinguish it from 54316 by the specific operation documented and the applicable billing code descriptor.
54316 billing questions
How does this differ from 54312?
54312 reports the first stage of a planned two-stage anterior urethral reconstruction. Report 54316 for the later operation that completes the reconstruction.
When would 54308 be considered instead?
54308 describes a one-stage anterior urethral reconstruction. The operative plan and work performed determine whether the repair is completed in one operation or as the second stage of a staged reconstruction.
What documentation supports reporting 54316?
The operative report should establish the staged reconstruction, identify the prior first-stage work, and describe the current procedure completing the urethral reconstruction.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inapplicable to this code, and modifier 50 is inappropriate.
How are other procedures in the same session paid?
Under the standard multiple-procedure rule, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction.
Is assistant or co-surgeon billing allowed?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
Fee sheets
Put 54316 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 →