Billing code 53420: Urethral reconstructionMedicare rate & RVUs in Illinois
Reports the initial operation in a planned two-stage urethral reconstruction, typically for a urethral stricture or defect requiring staged repair.
CMS doesn’t publish an office rate for 53420 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 53420 covers
A urologist or reconstructive urologist performs the first operation in a planned two-stage urethral repair. In a Johanson-type approach, the diseased segment is opened and the urethral bed is prepared to heal before a later operation completes the reconstruction. This staged approach may be selected for complex urethral narrowing or tissue deficiency when immediate tubular reconstruction is not appropriate. The service is generally performed in a hospital or other surgical facility.
Report 53420 for the initial reconstructive operation, not the later completion stage. The operative report should establish the urethral problem, the staged plan, the work performed at this operation, and any tissue used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment is restricted; co-surgeon payment requires 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 53420 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 | $844.60 |
| East St. Louis | Unavailable | $806.24 |
| Rest Of Illinois | Unavailable | $776.07 |
| Suburban Chicago | Unavailable | $815.63 |
How the 53420 rate is calculated
Each of 53420’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 · 53420
RVUs × geographic indexes × conversion factor
Work14.79
14.79 RVUs× 1.000 GPCI
Practice expense5.98
5.98 RVUs× 1.000 GPCI
Malpractice1.91
1.91 RVUs× 1.000 GPCI
Adjusted RVUs
22.6800
Conversion factor
$33.4009
Medicare rate
$757.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 53420
53420 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 53420
Urethral reconstruction
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 53420
Urethral reconstruction
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
53420 without 51 · national facility
$757.53
Urethral reconstruction
53420-51 · Second procedure: 50%
$378.77
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%).
53420 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 53425Urethral reconstruction
- Use 53420 for the initial operation in the planned staged repair; use 53425 for its second-stage completion.
- 53400Urethral repair
- 53400 is for a one-stage urethral reconstruction. Choose 53420 when the operative plan divides reconstruction into stages and this is the first operation.
- 53405Urethroplasty
- 53405 describes a staged urethral revision, while 53420 is for staged urethral reconstruction; the operative purpose distinguishes them.
53420 billing questions
How is 53420 different from 53425?
53420 represents the initial operation in the planned staged reconstruction. 53425 represents the later second-stage operation.
When would a single-stage urethral reconstruction code be considered instead?
Consider a single-stage code, such as 53400, when the surgeon completes the reconstruction in one operation rather than documenting a planned two-stage repair.
What documentation supports reporting 53420?
Document the urethral stricture or defect, why reconstruction is staged, the first-stage work performed, and the plan for the later stage.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect postoperative billing?
The 90-day global includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be billed?
CMS restricts assistant-at-surgery payment. Co-surgeon payment requires supporting documentation; 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 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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