No office rate
Code 53230 addresses removal of a urethral lesion. Use 53240 when the operative target is a urethral diverticulum.
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CMS RVU26D · Effective 2026-10-01
53240 Urethral surgery Medicare reimbursement rates in Iowa
Reports surgical excision of a urethral diverticulum in a female patient, typically performed by a urologist or urogynecologist when the diverticular sac requires operative treatment. Compare 53240 office and facility rates across CMS payment localities in Iowa.
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 53240 in Iowa?
Iowa 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
$362.99
1 of 1 localities have a supported rate.
Payment area: Iowa
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 53240: Female urethral diverticulum excision
Reports surgical excision of a urethral diverticulum in a female patient, typically performed by a urologist or urogynecologist when the diverticular sac requires operative treatment.
This code covers surgical removal of a urethral diverticulum in a female patient. A urologist or urogynecologist commonly approaches the diverticular sac through the vaginal wall, removes it, and addresses the urethral opening as needed. The procedure is performed in an operating room, generally in a hospital or ambulatory surgery center. The clinical problem is a urethral outpouching, not simply a focal urethral lesion or caruncle.
Report the code when the operative record supports excision of the diverticulum. Document the diagnosis, its location, the excision, and any urethral repair performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. 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 for this code. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 53240
- 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
- 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 RVU6.90 · 59%
- Practice expense (office) RVU3.95 · 34%
- Malpractice RVU0.89 · 8%
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.
53240 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
Code 53235 also concerns urethral lesion removal; it does not identify excision of a diverticular sac.
$152.50
Code 53200 reports a urethral biopsy, not definitive excision of a urethral diverticulum.
Compare 53240 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
Iowa →
Office / nonfacility
Unavailable
Facility
$362.99
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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 53240 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
6,185
- Code
- 53240
- Physician work
- 6.90
- Practice expense
- 3.95
- Malpractice
- 0.89
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.90 | × 1.000 | 6.9000 |
| Practice expense | 3.95 | × 0.915 | 3.6143 |
| Malpractice | 0.89 | × 0.397 | 0.3533 |
| Total RVUs | 10.8676 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$362.99
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.9 | 1 |
| Practice expense | 3.95 | 0.915 |
| Malpractice | 0.89 | 0.397 |
(6.9 × 1 + 3.95 × 0.915 + 0.89 × 0.397) × $33.4009 = $362.99
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.
53240 billing questions
How is this different from excision of a urethral lesion?
Use this code for excision of a urethral diverticulum. Codes 53230 and 53235 address urethral lesions, rather than removal of a diverticular sac.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care.
Can an assistant surgeon or co-surgeon be paid?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction.
What documentation supports reporting this code?
Document the urethral diverticulum and its location, the operative excision, and any urethral repair performed.
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.
6,18253220,,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
6,18353230,,Removal of urethra lesion,A,,10.18,4.94,NA,4.94,,1.47,16.59,16.59,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18453235,,Removal of urethra lesion,A,,10.72,5.21,NA,5.21,,1.36,17.29,17.29,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18553240,,Surgery for urethra pouch,A,,6.90,3.95,NA,3.95,,0.89,11.74,11.74,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18653250,,Removal of urethra gland,A,,6.36,3.82,NA,3.82,,0.82,11.00,11.00,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18753260,,Treatment of urethra lesion,A,,2.95,3.02,,1.58,,0.43,6.40,4.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18853265,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136