Billing code 50125: PyelotomyMedicare rate & RVUs in Illinois
Reports open access to the renal pelvis with creation of a drainage route when the surgeon needs sustained drainage from the upper urinary tract.
CMS doesn’t publish an office rate for 50125 in Illinois.
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 50125 covers
A urologist performs this open operation by entering the renal pelvis and creating a pyelostomy to provide drainage. It is distinct from simply opening the pelvis to inspect it or removing a calculus through the incision. The operative report should identify the side, the renal pelvis work, and the drainage route created. This service is generally performed in an operating room rather than as an office procedure.
The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. For bilateral performance, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons are paid only with 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.
Where 50125 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $983.34 |
| East St. Louis | Unavailable | $939.08 |
| Rest Of Illinois | Unavailable | $904.05 |
| Suburban Chicago | Unavailable | $949.57 |
How the 50125 rate is calculated
Each of 50125’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 · 50125
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 17.37Practice expense 6.82Malpractice 2.22
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 50125
50125 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 50125
Pyelotomy
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 50125
Pyelotomy
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 50 · payment effect
With and without the modifier
50125 without 50 · national facility
$882.12
Pyelotomy
50125-50 · Bilateral: 150%
$1,323.18
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
50125 compared with similar codes
Compare codes
50125 vs 50120 vs 50130 vs 50040 vs 50432: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 50120Pyelotomy
- Choose 50120 for opening and exploring the renal pelvis without creating the drainage route described here.
- 50130Stone removal
- Choose 50130 when the operative work removes a calculus through the renal pelvis; this code centers on creating a drainage route.
- 50040Renal drainage
- 50040 describes open nephrostomy or nephrotomy with drainage at the kidney. This code identifies drainage established through the renal pelvis.
- 50432Nephrostomy placement
- 50432 is for percutaneous placement of a nephrostomy catheter. This code describes open surgical renal pelvis work with a pyelostomy.
50125 billing questions
How does this differ from 50120?
50120 describes opening the renal pelvis for exploration. This code is selected when the operation also establishes a pyelostomy drainage route.
When would 50130 be more appropriate?
50130 describes an operation that removes a calculus through the renal pelvis. This code describes creation of a drainage route, not calculus removal as its defining work.
What should the operative note document?
Document the side, the renal pelvis incision, and the pyelostomy or other drainage route established. Include any separately performed procedures and their distinct work.
How is bilateral performance reported?
When the procedure is performed on both sides, report modifier 50; CMS pays bilateral performance at 150%.
How does the multiple-procedure reduction affect payment?
When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others 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 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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