No office rate
51590 describes bladder removal with urinary diversion. Choose 51597 when the operation is a complete pelvic exenteration involving the bladder and other pelvic organs.
On this page
CMS RVU26D · Effective 2026-10-01
51597 Pelvic exenteration Medicare reimbursement rates in Hawaii
Reports complete pelvic cancer surgery removing the bladder and other pelvic organs, with urinary diversion created as part of the operation. Compare 51597 office and facility rates across CMS payment localities in Hawaii.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 51597 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2021.60
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Pelvic oncology surgery
About 51597: Complete pelvic exenteration with urinary diversion
Reports complete pelvic cancer surgery removing the bladder and other pelvic organs, with urinary diversion created as part of the operation.
Code 51597 represents radical pelvic cancer surgery that removes the bladder and other involved pelvic organs in a single exenterative procedure and includes creation of a urinary diversion. The organs removed depend on the tumor site and extent; resection may involve the rectosigmoid, reproductive organs, or adjacent pelvic structures. Urologic or gynecologic oncologic surgeons typically perform the operation in a hospital operating room, with colorectal expertise when bowel resection is needed.
Report this code for complete exenteration rather than a bladder-only cystectomy. The operative report should identify the malignancy, organs removed, extent of resection, and urinary diversion created. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this central-organ operation. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 51597
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU41.79 · 68%
- Practice expense (office) RVU13.56 · 22%
- Malpractice RVU5.73 · 9%
234
Medicare services in 2024 · #4188 by national volume
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.
51597 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
51595 combines bladder removal, urinary diversion, and bilateral pelvic lymphadenectomy; it does not describe the broader multiorgan exenteration reported with 51597.
No office rate
51596 describes bladder removal with a continent urinary reservoir. Choose 51597 for complete pelvic exenteration with urinary diversion as part of the broader cancer operation.
Compare 51597 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$2021.60
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 51597 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
6,041
- Code
- 51597
- Physician work
- 41.79
- Practice expense
- 13.56
- Malpractice
- 5.73
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 41.79 | × 1.000 | 41.7900 |
| Practice expense | 13.56 | × 1.137 | 15.4177 |
| Malpractice | 5.73 | × 0.579 | 3.3177 |
| Total RVUs | 60.5254 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$2021.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 41.79 | 1 |
| Practice expense | 13.56 | 1.137 |
| Malpractice | 5.73 | 0.579 |
(41.79 × 1 + 13.56 × 1.137 + 5.73 × 0.579) × $33.4009 = $2021.60
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
51597 billing questions
How is 51597 different from a cystectomy code?
Use 51597 for complete pelvic exenteration for malignancy involving the bladder and other pelvic organs, with urinary diversion. A cystectomy code describes bladder removal with a specified diversion or other features, not the broader exenterative operation.
What operative details support reporting 51597?
Document the malignancy, the organs removed, the extent of the exenteration, and the urinary diversion created. These details distinguish the procedure from bladder-only removal.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this operation because it addresses removal of central pelvic organs as an exenterative procedure.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50% when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,03851590,,Remove bladder/revise tract,A,,35.42,11.12,NA,11.12,,4.71,51.25,51.25,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,03951595,,Remove bladder/revise tract,A,,40.29,12.35,NA,12.35,,5.29,57.93,57.93,0,090,0.08,0.83,0.09,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,04051596,,Remove bladder/create pouch,A,,43.15,13.68,NA,13.68,,5.69,62.52,62.52,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,04151597,,Removal of pelvic structures,A,,41.79,13.56,NA,13.56,,5.73,61.08,61.08,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,04251600,,Injection for bladder x-ray,A,,0.86,5.26,,0.17,,0.09,6.21,1.12,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,04351605,,Preparation for bladder xray,A,,0.62,0.36,NA,0.36,,0.07,1.05,1.05,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,04451610,,Injection for bladder x-ray,A,,1.02,2.70,,0.59,,0.12,3.84,1.73,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014