$339.20–$371.98
Use this code for sampling urethral tissue. Code 52204 describes biopsy during cystourethroscopy and is commonly associated with a bladder biopsy; identify the actual target and procedure in the record.
On this page
CMS RVU26D · Effective 2026-10-01
53200 Urethral biopsy Medicare reimbursement rates in Illinois
Reports targeted sampling of urethral tissue for diagnostic evaluation of a suspicious mucosal abnormality or lesion. Compare 53200 office and facility rates across CMS payment localities in Illinois.
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 53200 in Illinois?
Illinois has 4 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 4 payment areas shown below, using the same CMS release.
Office / nonfacility
$167.16–$183.37
4 of 4 localities have a supported rate.
Facility setting
$132.40–$145.11
4 of 4 localities have a supported rate.
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.
Where 53200 pays more and less in Illinois
4 payment localities
$167.16 to $183.37
Urology procedure
About 53200: Urethral tissue biopsy
Reports targeted sampling of urethral tissue for diagnostic evaluation of a suspicious mucosal abnormality or lesion.
A urologist samples tissue from a urethral abnormality when examination raises concern for a condition that requires histologic evaluation. The service may be performed in an office procedure setting or a facility, with the approach guided by the location and visibility of the abnormal tissue. The specimen is sent for pathology; the code represents diagnostic tissue sampling rather than treatment that removes or destroys the lesion.
Report the service when the operative or procedure note identifies the urethral site sampled and supports that tissue was obtained for diagnosis. Distinguish urethral sampling from cystourethroscopic biopsy directed to the bladder, and from therapeutic treatment or excision of a urethral lesion. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is 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. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 53200
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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 RVU2.53 · 51%
- Practice expense (office) RVU2.06 · 41%
- Malpractice RVU0.38 · 8%
273
Medicare services in 2024 · #4067 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.
53200 compared with similar codes
Office rates for Illinois, from the same CMS release.
No office rate
This code is for diagnostic tissue sampling. Code 53220 represents treatment of a urethral lesion, so select it when the service is therapeutic rather than obtaining tissue for diagnosis.
No office rate
This code represents sampling for diagnosis; 53230 represents removal of a urethral lesion. Report the removal service when the lesion is excised rather than merely sampled.
Compare 53200 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.
4 of 4 payment localities
Chicago →
Office / nonfacility
$183.37
Facility
$145.11
East St. Louis →
Office / nonfacility
$173.37
Facility
$138.34
Rest Of Illinois →
Office / nonfacility
$167.16
Facility
$132.40
Suburban Chicago →
Office / nonfacility
$178.25
Facility
$139.15
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53200 billing questions
How does this differ from 52204?
This code represents sampling of urethral tissue. Code 52204 describes biopsy work performed during cystourethroscopy, commonly for a bladder target; document the actual biopsy site and procedure.
Can this be reported with treatment of the same urethral lesion?
A diagnostic sample and a therapeutic procedure are distinct services, but documentation must establish that both were performed and that the biopsy was not simply part of the treatment. Check applicable coding edits before reporting both.
Should modifier 50 be appended for sampling both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not use modifier 50.
What documentation supports reporting this service?
Record the urethral location, the abnormal tissue sampled, the diagnostic reason for sampling, and that tissue was obtained and submitted for examination.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and applies the standard 50% multiple-procedure reduction to the other procedures. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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.
6,17653060,,Drainage of urethra abscess,A,,2.61,2.65,,1.40,,0.45,5.71,4.46,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17753080,,Drainage of urinary leakage,A,,6.75,4.04,NA,4.04,,0.87,11.66,11.66,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17853085,,Drainage of urinary leakage,A,,10.90,5.39,NA,5.39,,1.40,17.69,17.69,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17953200,,Biopsy of urethra,A,,2.53,2.06,,0.92,,0.38,4.97,3.83,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18053210,,Removal of urethra,A,,13.38,5.73,NA,5.73,,1.72,20.83,20.83,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18153215,,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