$170.09
53200 is for biopsy of the urethra to obtain tissue; 53265 is for treating a lesion.
On this page
CMS RVU26D · Effective 2026-10-01
53265 Urethral treatment Medicare reimbursement rates in Hawaii
Reports treatment directed at a urethral lesion, rather than diagnostic sampling alone or a separately described lesion-removal procedure. Compare 53265 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 53265 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
$240.47
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$170.97
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.
Urology procedure
About 53265: Urethral lesion treatment
Reports treatment directed at a urethral lesion, rather than diagnostic sampling alone or a separately described lesion-removal procedure.
CPT 53265 represents treatment directed at a lesion of the urethra. A urologist may perform the service in an office or facility after identifying a lesion during evaluation of urethral symptoms or endoscopic assessment. The note should identify the lesion’s location and describe the treatment performed. The code label alone does not establish that the lesion is a caruncle, polyp, or another specific type, so the documented service must support this code rather than a more specifically described procedure.
The code has a 10-day global period, which includes related postoperative visits during that period. 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 multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted. Documentation should support the urethral site, the lesion treated, and the service performed.
CMS billing rules for 53265
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.09 · 45%
- Practice expense (office) RVU3.38 · 49%
- Malpractice RVU0.46 · 7%
1.1K
Medicare services in 2024 · #2919 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.
53265 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
Both carry a CMS short descriptor for urethral-lesion treatment. Confirm the full CPT descriptor and the documented service when distinguishing them.
No office rate
53230 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.
No office rate
53235 is identified as removal of a urethral lesion; 53265 is identified as treatment of a urethral lesion.
Compare 53265 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
$240.47
Facility
$170.97
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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 53265 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
6,188
- Code
- 53265
- Physician work
- 3.09
- Practice expense
- 3.38
- Malpractice
- 0.46
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.09 | × 1.000 | 3.0900 |
| Practice expense | 3.38 | × 1.137 | 3.8431 |
| Malpractice | 0.46 | × 0.579 | 0.2663 |
| Total RVUs | 7.1994 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$240.47
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.09 | 1 |
| Practice expense | 3.38 | 1.137 |
| Malpractice | 0.46 | 0.579 |
(3.09 × 1 + 3.38 × 1.137 + 0.46 × 0.579) × $33.4009 = $240.47
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.09 | 1 |
| Practice expense | 1.55 | 1.137 |
| Malpractice | 0.46 | 0.579 |
(3.09 × 1 + 1.55 × 1.137 + 0.46 × 0.579) × $33.4009 = $170.97
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.
53265 billing questions
When should 53265 be chosen instead of a urethral biopsy code?
Use 53265 for treatment of the lesion. Use 53200 when the service is a biopsy to obtain tissue for diagnosis.
How does 53265 differ from urethral lesion-removal codes?
53265 describes treatment of a urethral lesion. Codes 53230 and 53235 describe removal of a urethral lesion; report the code that matches the documented procedure.
Are related postoperative visits separately included?
Related postoperative visits during the 10-day global period are included in 53265.
Can modifier 50 be used for treatment on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 53265. Co-surgeons and team surgery are not permitted.
What happens if another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
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.
6,18553240,,Surgery for urethra pouch,A,,6.90,3.95,NA,3.95,,0.89,11.74,11.74,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18653250,,Removal of urethra gland,A,,6.36,3.82,NA,3.82,,0.82,11.00,11.00,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18753260,,Treatment of urethra lesion,A,,2.95,3.02,,1.58,,0.43,6.40,4.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18853265,,Treatment of urethra lesion,A,,3.09,3.38,,1.55,,0.46,6.93,5.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18953270,,Removal of urethra gland,A,,3.06,3.10,,1.61,,0.40,6.56,5.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19053275,,Repair of urethra defect,A,,4.46,2.06,NA,2.06,,0.62,7.14,7.14,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19153400,,Revise urethra stage 1,A,,13.78,6.06,NA,6.06,,1.83,21.67,21.67,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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