Billing code 54390: Genital reconstructionMedicare rate & RVUs in Guam
Reports complex reconstructive surgery addressing epispadias together with bladder exstrophy, involving repair of the bladder and associated penile anatomy.
CMS doesn’t publish an office rate for 54390 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 54390 covers
This code describes a major reconstructive operation for bladder exstrophy with epispadias, a congenital condition involving an exposed bladder and abnormal development of the penis and urethra. The operation addresses the bladder and penile anatomy as part of the same reconstruction. Pediatric urologists typically perform it in a hospital operating room; the clinical record should establish the combined anatomic problem and the reconstructive work performed.
Report the code when the operative service matches this combined repair, rather than an isolated epispadias repair or a urethral reconstruction for a different defect. The operative report should document the bladder and penile findings and the procedures performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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.
54390 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,107.46 |
How the 54390 rate is calculated
Each of 54390’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 · 54390
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 22.20Practice expense 8.18Malpractice 2.86
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 54390
54390 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 54390
Genital 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 · 54390
Genital 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
54390 without 51 · national facility
$1,110.25
Genital reconstruction
54390-51 · Second procedure: 50%
$555.13
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%).
54390 compared with similar codes
Compare codes
54390 vs 54380 vs 54385 vs 54308: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 54380Epispadias repair
- This code addresses bladder exstrophy together with epispadias. Code 54380 is an epispadias repair for a different operative scope.
- 54385Penile repair
- Use 54390 for the combined bladder exstrophy and epispadias repair; distinguish 54385 by the specific epispadias operation documented.
- 54308Urethral reconstruction
- Code 54308 describes anterior urethral reconstruction. It is not the combined bladder and penile reconstruction represented by 54390.
54390 billing questions
When should this code be chosen over a code for epispadias repair alone?
Use this code when the operation repairs bladder exstrophy together with the associated epispadias. An isolated epispadias repair without bladder exstrophy is a different service.
Does the 90-day global period include routine postoperative visits?
Yes. The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
What should the operative report establish?
Document the bladder exstrophy and associated epispadias, the anatomy addressed, and the reconstructive work performed on the bladder and penis.
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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