Billing code 53230: Lesion excisionMedicare rate & RVUs in Illinois
Surgical excision of a urethral lesion at the more involved level, reported when operative documentation supports this extent rather than a simpler or more extensive excision.
CMS doesn’t publish an office rate for 53230 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 53230 covers
A urologist surgically removes a lesion arising in the urethra. This code represents a more involved excision level than a simple lesion removal; it is not a code for obtaining a tissue sample alone or for destroying a lesion without excision. The service is generally performed in an operating-room setting when the lesion’s location or operative work calls for surgical removal.
Choose this level from the documented procedure and extent of the excision, distinguishing it from simpler removal and the more extensive sibling level. The operative report should identify the urethral lesion and describe the work performed. This major surgery 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% reduction. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment 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 53230 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 | $620.91 |
| East St. Louis | Unavailable | $590.71 |
| Rest Of Illinois | Unavailable | $567.41 |
| Suburban Chicago | Unavailable | $598.86 |
How the 53230 rate is calculated
Each of 53230’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 · 53230
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.18Practice expense 4.94Malpractice 1.47
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53230
53230 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 53230
Lesion excision
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 53230
Lesion excision
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 51 · payment effect
With and without the modifier
53230 without 51 · national facility
$554.12
Lesion excision
53230-51 · Second procedure: 50%
$277.06
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
53230 compared with similar codes
Compare codes
53230 vs 53220 vs 53235 vs 53200 vs 53215: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 53220Urethral lesion treatment
- 53220 is the simpler urethral lesion excision level. Report 53230 when the operative documentation supports the more involved level.
- 53235Urethral excision
- 53235 represents a more extensive excision level than 53230. Base the choice on the documented extent of the operation.
- 53200Urethral biopsy
- 53200 is for biopsy, which obtains tissue for diagnosis. 53230 reports surgical removal of the lesion rather than sampling alone.
- 53215Urethrectomy
- 53215 describes partial removal of the urethra, not excision of a urethral lesion while preserving the urethra.
53230 billing questions
How do I distinguish this code from 53220?
Use 53230 for the more involved excision level. The operative documentation should support that level rather than the simpler lesion removal represented by 53220.
When is 53235 a better choice?
53235 represents the more extensive sibling level. Compare the documented operative work with the distinctions among the excision levels rather than choosing by the lesion diagnosis alone.
Does the excision have a global period?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team-surgery payment is not permitted.
How does the multiple-procedure reduction work?
For procedures performed in the same session, the highest-valued procedure is paid in full and the other procedures are subject to the standard 50% reduction.
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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