$152.50
53200 is for biopsy of urethral tissue. Use 53275 when the documented operative service repairs a defect rather than sampling tissue.
On this page
CMS RVU26D · Effective 2026-10-01
53275 Urethral repair Medicare reimbursement rates in Iowa
Reports operative closure or reconstruction of a urethral defect, such as a defect left by injury or prior surgery, rather than lesion removal alone. Compare 53275 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 53275 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
$220.15
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.
Urologic surgery
About 53275: Urethral defect repair
Reports operative closure or reconstruction of a urethral defect, such as a defect left by injury or prior surgery, rather than lesion removal alone.
This code is for operative repair of a defect in the urethra. A urologist typically performs the procedure in an operating room when the urethral wall needs surgical closure or reconstruction, including a defect associated with trauma or prior treatment. The operative report should identify the defect and describe the repair performed; a biopsy, lesion treatment, or removal procedure by itself is not this service.
Report the code for the urethral defect repair, not simply because the urethra was exposed or examined during another operation. Related postoperative visits are included for 10 days. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 53275
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU4.46 · 62%
- Practice expense (office) RVU2.06 · 29%
- Malpractice RVU0.62 · 9%
161
Medicare services in 2024 · #4505 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.
53275 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
53220 addresses treatment of a urethral lesion. Choose 53275 when the work is repair of a defect, not lesion-directed treatment.
No office rate
53230 is a urethral lesion removal code. It does not describe repair of a urethral defect.
No office rate
53240 describes surgery for a urethral pouch. Use 53275 for repair of a urethral defect when the operative service is not pouch surgery.
Compare 53275 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
$220.15
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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 53275 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
6,190
- Code
- 53275
- Physician work
- 4.46
- Practice expense
- 2.06
- Malpractice
- 0.62
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.46 | × 1.000 | 4.4600 |
| Practice expense | 2.06 | × 0.915 | 1.8849 |
| Malpractice | 0.62 | × 0.397 | 0.2461 |
| Total RVUs | 6.5910 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$220.15
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.46 | 1 |
| Practice expense | 2.06 | 0.915 |
| Malpractice | 0.62 | 0.397 |
(4.46 × 1 + 2.06 × 0.915 + 0.62 × 0.397) × $33.4009 = $220.15
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.
53275 billing questions
When should this be reported instead of a urethral lesion procedure?
Report 53275 when the operative service repairs a urethral defect. A procedure directed at treating or removing a urethral lesion is represented by the applicable lesion code instead.
Does the code include related postoperative visits?
Yes. Related postoperative visits during the 10-day global period are included.
Can modifier 50 be used for a repair involving both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other procedures in the same session paid?
Medicare pays the highest-valued procedure in full and reduces the other procedures under the standard multiple-procedure rule.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What documentation supports reporting the repair?
Document the location and nature of the urethral defect and the operative steps used to repair it. The note should distinguish repair from biopsy, lesion treatment, or excision.
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.
6,18753260,,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
6,18953270,,Removal of urethra gland,A,,3.06,3.10,,1.61,,0.40,6.56,5.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19053275,,Repair of urethra defect,A,,4.46,2.06,NA,2.06,,0.62,7.14,7.14,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19153400,,Revise urethra stage 1,A,,13.78,6.06,NA,6.06,,1.83,21.67,21.67,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19253405,,Revise urethra stage 2,A,,15.27,6.34,NA,6.34,,1.96,23.57,23.57,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19353410,,Reconstruction of urethra,A,,17.24,6.87,NA,6.87,,2.22,26.33,26.33,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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