No office rate
53230 is the male counterpart. 53235 is for excision of a urethral lesion in a female patient.
On this page
CMS RVU26D · Effective 2026-10-01
53235 Urethral excision Medicare reimbursement rates in Idaho
Reports surgical excision of a urethral lesion in a female patient when the lesion is removed rather than sampled by biopsy or destroyed. Compare 53235 office and facility rates across CMS payment localities in Idaho.
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 53235 in Idaho?
Idaho 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
$539.64
1 of 1 localities have a supported rate.
Payment area: Idaho
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 surgery
About 53235: Female urethral lesion excision
Reports surgical excision of a urethral lesion in a female patient when the lesion is removed rather than sampled by biopsy or destroyed.
This service involves surgically removing a lesion from the female urethra. A urologist or another surgeon with appropriate expertise typically performs the procedure in a facility setting. The excised tissue may be submitted for pathologic examination. This code describes removal of a lesion, not a limited tissue sample for diagnosis or destruction of the lesion without excision.
Report the code for the female patient when the operative record supports excision of a urethral lesion. Document the lesion’s location and appearance, the operative approach, and the work performed to remove it. The code has a 90-day global period: the day-before preoperative visit and related postoperative care during that period are 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. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is not appropriate for this descriptor and anatomy.
CMS billing rules for 53235
- 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 RVU10.72 · 62%
- Practice expense (office) RVU5.21 · 30%
- Malpractice RVU1.36 · 8%
23
Medicare services in 2024 · #5849 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.
53235 compared with similar codes
Office rates for Idaho, from the same CMS release.
$153.81
53200 reports biopsy sampling of the urethra. Choose 53235 when the operative service removes the lesion.
$198.13
53260 is for destruction of a urethral lesion. 53235 represents surgical excision.
$214.34
53265 is also a urethral lesion destruction code. Use the destruction code when the lesion is destroyed rather than removed by excision.
Compare 53235 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
Idaho →
Office / nonfacility
Unavailable
Facility
$539.64
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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 53235 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
6,184
- Code
- 53235
- Physician work
- 10.72
- Practice expense
- 5.21
- Malpractice
- 1.36
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.72 | × 1.000 | 10.7200 |
| Practice expense | 5.21 | × 0.920 | 4.7932 |
| Malpractice | 1.36 | × 0.473 | 0.6433 |
| Total RVUs | 16.1565 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$539.64
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.72 | 1 |
| Practice expense | 5.21 | 0.92 |
| Malpractice | 1.36 | 0.473 |
(10.72 × 1 + 5.21 × 0.92 + 1.36 × 0.473) × $33.4009 = $539.64
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.
53235 billing questions
How does this code differ from 53230?
53235 is for excision of a urethral lesion in a female patient; 53230 is the corresponding male code. Select based on the patient and operative service.
When should 53200 be reported instead?
53200 describes a urethral biopsy, in which tissue is sampled for diagnosis. Use 53235 when the documented service is excision of the lesion rather than a biopsy.
Can lesion destruction codes be used instead?
Codes 53260 and 53265 describe destruction of a urethral lesion. They are alternatives when the lesion is destroyed rather than surgically excised.
Should modifier 50 be appended?
No. Modifier 50 is not appropriate for this descriptor and anatomy.
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.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other 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.
6,18153215,,Removal of urethra,A,,16.43,6.37,NA,6.37,,2.13,24.93,24.93,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18253220,,Treatment of urethra lesion,A,,7.44,4.05,NA,4.05,,0.96,12.45,12.45,0,090,0.08,0.83,0.09,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18353230,,Removal of urethra lesion,A,,10.18,4.94,NA,4.94,,1.47,16.59,16.59,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18453235,,Removal of urethra lesion,A,,10.72,5.21,NA,5.21,,1.36,17.29,17.29,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18553240,,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
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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772