Billing code 53200: Urethral biopsyMedicare rate & RVUs in Georgia
Reports targeted sampling of urethral tissue for diagnostic evaluation of a suspicious mucosal abnormality or lesion.
Medicare pays $161.01–$169.91 for 53200 in the office in Georgia, from Rest Of Georgia to Atlanta. Which amount applies depends on the service address.
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 53200 covers
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.
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 53200 pays more and less in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | $169.91 | $131.22 |
| Rest Of Georgia | $161.01 | $127.04 |
How the 53200 rate is calculated
Each of 53200’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 · 53200
RVUs × geographic indexes × conversion factor
Work2.53
2.53 RVUs× 1.000 GPCI
Practice expense2.06
2.06 RVUs× 1.000 GPCI
Malpractice0.38
0.38 RVUs× 1.000 GPCI
Adjusted RVUs
4.9700
Conversion factor
$33.4009
Medicare rate
$166.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 53200
The CMS indicators that decide how 53200 is paid alongside other services.
CMS payment indicators · 53200
Urethral biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
53200 without 51 · national office
$166.00
Urethral biopsy
53200-51 · Second procedure: 50%
$83.00
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%).
53200 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52204Cystoscopic biopsy
- 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.
- 53220Urethral lesion treatment
- 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.
- 53230Lesion excision
- 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.
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 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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