No office rate
53400 identifies stage one; 53405 identifies stage two. Use the operative report to establish which portion of the planned repair occurred.
On this page
CMS RVU26D · Effective 2026-10-01
53400 Urethral repair Medicare reimbursement rates in Idaho
Reports the first stage of a planned urethral reconstruction, typically performed by a urologist to repair a urethral abnormality such as a stricture. Compare 53400 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 53400 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
$675.39
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 53400: Stage-one urethral reconstruction
Reports the first stage of a planned urethral reconstruction, typically performed by a urologist to repair a urethral abnormality such as a stricture.
A urologist performs the initial operative portion of a staged urethral reconstruction or revision. The procedure addresses a urethral abnormality, such as a stricture, when the surgeon plans the repair in stages rather than completing it in one operation. It is generally performed in an operating room, with the operative report identifying the urethral site and describing the work completed during this stage.
Report 53400 when the documented service is the stage-one urethral repair, not the later stage. The operative report should support the staged plan and distinguish this work from a one-stage reconstruction or a different urethral revision. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53400
- 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 RVU13.78 · 64%
- Practice expense (office) RVU6.06 · 28%
- Malpractice RVU1.83 · 8%
182
Medicare services in 2024 · #4410 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.
53400 compared with similar codes
Office rates for Idaho, from the same CMS release.
No office rate
Both are urethral reconstruction services, but 53410 is a distinct procedure code. Choose based on the operative procedure and applicable descriptor, not the shared general purpose of repairing the urethra.
53450
No office rateUrethral revision
53450 is a separate urethral revision code. Use 53400 when the documentation supports the stage-one reconstruction represented by this code, rather than selecting by the general term revision alone.
Compare 53400 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
$675.39
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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 53400 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
6,191
- Code
- 53400
- Physician work
- 13.78
- Practice expense
- 6.06
- Malpractice
- 1.83
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.78 | × 1.000 | 13.7800 |
| Practice expense | 6.06 | × 0.920 | 5.5752 |
| Malpractice | 1.83 | × 0.473 | 0.8656 |
| Total RVUs | 20.2208 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Idaho$675.39
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.78 | 1 |
| Practice expense | 6.06 | 0.92 |
| Malpractice | 1.83 | 0.473 |
(13.78 × 1 + 6.06 × 0.92 + 1.83 × 0.473) × $33.4009 = $675.39
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.
53400 billing questions
How is 53400 distinguished from 53405?
53400 identifies the stage-one urethral repair; 53405 identifies the subsequent stage. The operative report should make the stage performed clear.
Can 53400 be reported for a one-stage urethral reconstruction?
Use 53400 when the documented service is stage one of the urethral repair. A one-stage reconstruction should be selected according to its applicable code and documented procedure.
What documentation supports 53400?
The operative report should identify the urethral abnormality and site, describe the reconstruction performed, and establish that this was the first stage of the repair.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90-day period are included in the global surgical service.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery 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.
6,18853265,,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
6,19253405,,Revise urethra stage 2,A,,15.27,6.34,NA,6.34,,1.96,23.57,23.57,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19353410,,Reconstruction of urethra,A,,17.24,6.87,NA,6.87,,2.22,26.33,26.33,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19453415,,Reconstruction of urethra,A,,20.18,7.49,NA,7.49,,2.61,30.28,30.28,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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