CPT code 51820: Outlet reconstruction2026 Medicare rate & RVUs in Guam
Complex reconstructive surgery of the urethra or bladder neck, reported when operative repair goes beyond a straightforward revision of these structures.
CMS doesn’t publish an office rate for 51820 in Guam.
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 51820 covers
A urologist performs this reconstructive operation to correct a complex abnormality involving the urethra or bladder neck. It may be used for congenital or acquired structural problems, including defects encountered after prior surgery. The surgeon reshapes or reconstructs the affected outlet anatomy in an operating room; this is distinct from simply closing a bladder wound or supporting pelvic organs for prolapse or incontinence.
Report the code when the operative work supports a complicated reconstructive repair, rather than the less complex related procedure. The operative note should identify the affected anatomy, the underlying problem, and the reconstructive work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. 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.
51820 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $975.11 |
How the 51820 rate is calculated
Each of 51820’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 · 51820
RVUs × geographic indexes × conversion factor
Work19.10
19.10 RVUs× 1.000 GPCI
Practice expense7.62
7.62 RVUs× 1.000 GPCI
Malpractice2.47
2.47 RVUs× 1.000 GPCI
Adjusted RVUs
29.1900
Conversion factor
$33.4009
Medicare rate
$974.97
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 51820
51820 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 51820
Outlet 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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 51820
Outlet 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
51820 without 51 · national facility
$974.97
Outlet reconstruction
51820-51 · Second procedure: 50%
$487.49
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%).
51820 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 51800Bladder outlet reconstruction
- Both address urethral or bladder-neck reconstruction, but 51820 represents the complicated service; 51800 is the less complex related code.
- 51860Bladder repair
- 51860 is for simple closure of a bladder wound. Choose 51820 when the operation reconstructs a complex urethral or bladder-neck abnormality instead.
- 51865Bladder wound repair
- 51865 concerns complicated repair of a bladder wound, while 51820 describes complicated reconstruction of the urethra or bladder neck.
- 51845Bladder neck repair
- 51845 is a bladder-neck suspension procedure for stress incontinence; 51820 addresses reconstructive correction of abnormal outlet anatomy.
51820 billing questions
How does this differ from 51800?
51820 is for the complicated reconstructive service. Use 51800 for the less complex related urethral or bladder-neck reconstruction when the operative work supports that level.
Should modifier 50 be appended for bilateral work?
CMS prices this code as bilateral. Modifier 50 does not increase payment.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
What should the operative note establish?
Document the urethral or bladder-neck abnormality, the anatomy addressed, and the reconstructive steps that support a complicated repair.
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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