Billing code 52400: Valve incisionMedicare rate & RVUs in Florida
Endoscopic incision of congenital posterior urethral valves is reported when a urologist surgically relieves this outlet obstruction through the urethra.
CMS doesn’t publish an office rate for 52400 in Florida.
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 52400 covers
A urologist uses a cystoscope passed through the urethra to locate and incise congenital posterior urethral valves or a congenital posterior urethral obstruction. The procedure is commonly performed in a hospital or ambulatory surgical setting, often by a pediatric urologist for a child with bladder outlet obstruction. The operative service is the corrective incision, not cystoscopic inspection alone.
Report 52400 when the operative findings and documentation support treatment of a congenital posterior urethral valve or obstruction. The record should identify the congenital abnormality, describe the endoscopic findings and incision performed, and document the outcome. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are 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 52400 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $459.03 |
| Miami | Unavailable | $488.33 |
| Rest Of Florida | Unavailable | $441.72 |
How the 52400 rate is calculated
Each of 52400’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 · 52400
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 8.47Practice expense 3.26Malpractice 1.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 52400
52400 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 52400
Valve incision
| 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 | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 52400
Valve incision
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
52400 without 51 · national facility
$428.20
Valve incision
52400-51 · Second procedure: 50%
$214.10
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%).
52400 compared with similar codes
Compare codes
52400 vs 52276 vs 52281 vs 52000: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 52276Urethral stricture treatment
- Choose 52400 for congenital posterior urethral valves or obstruction; choose 52276 for incision of a urethral stricture.
- 52281Urethral dilation
- 52400 reports incision of a congenital posterior valve or obstruction. Code 52281 describes cystoscopic dilation of a urethral stricture or stenosis.
- 52000Cystoscopy
- 52000 is diagnostic cystourethroscopy without the corrective valve incision. Report 52400 when the congenital obstruction is incised endoscopically.
52400 billing questions
How does 52400 differ from direct vision internal urethrotomy?
52400 treats congenital posterior urethral valves or congenital posterior urethral obstruction. Direct vision internal urethrotomy, 52276, is used for a urethral stricture.
Can diagnostic cystoscopy be reported separately?
52400 describes the therapeutic incision performed through cystoscopic access. When the encounter includes the valve incision, do not treat the inspection needed to perform that incision as a separate diagnostic service.
Is modifier 50 appropriate for bilateral findings?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant surgeon or co-surgeon be paid?
Medicare does not pay an assistant at surgery for 52400. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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
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