No office rate
This code addresses a urethral defect. Code 53502 is for urethral injury repair; base selection on the operative diagnosis and the full descriptor.
On this page
CMS RVU26D · Effective 2026-10-01
53520 Urethral repair Medicare reimbursement rates in Kentucky
Repair a documented urethral defect by operative closure or reconstruction, distinguishing this service from repair of a urethral injury. Compare 53520 office and facility rates across CMS payment localities in Kentucky.
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 53520 in Kentucky?
Kentucky 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
$490.80
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 53520: Urethral defect repair
Repair a documented urethral defect by operative closure or reconstruction, distinguishing this service from repair of a urethral injury.
A urologist or other qualified surgeon uses this code for operative repair of a defect in the urethra. The procedure addresses the urethral defect itself, with the operative approach and repair tailored to its location and extent. It is generally performed in an operating room rather than as an office service.
Report the code when the operative note identifies the urethral defect and describes the repair performed; distinguish a defect repair from a repair coded specifically as treatment of a urethral injury. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. 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% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code, and co-surgeons and team surgery are not permitted.
CMS billing rules for 53520
- 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 RVU9.24 · 60%
- Practice expense (office) RVU4.90 · 32%
- Malpractice RVU1.20 · 8%
37
Medicare services in 2024 · #5541 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.
53520 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Use 53520 for repair of a documented urethral defect, not an injury repair described by 53505.
No office rate
Code 53510 describes urethral injury repair. This code is for repair of a urethral defect rather than an injury.
No office rate
Choose 53515 when the operative service meets its injury-repair description; use this code for a urethral defect repair.
Compare 53520 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$490.80
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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 53520 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,218
- Code
- 53520
- Physician work
- 9.24
- Practice expense
- 4.90
- Malpractice
- 1.20
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.24 | × 1.000 | 9.2400 |
| Practice expense | 4.90 | × 0.889 | 4.3561 |
| Malpractice | 1.20 | × 0.915 | 1.0980 |
| Total RVUs | 14.6941 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$490.80
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.24 | 1 |
| Practice expense | 4.9 | 0.889 |
| Malpractice | 1.2 | 0.915 |
(9.24 × 1 + 4.9 × 0.889 + 1.2 × 0.915) × $33.4009 = $490.80
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.
53520 billing questions
How is this code distinguished from the urethral injury repair codes?
Use this code for repair of a documented urethral defect. Codes 53502, 53505, 53510, and 53515 address urethral injury repair; select among them using the specific injury circumstances and the full code descriptions.
What documentation supports reporting this service?
The operative report should identify the urethral defect, describe its location and extent, and explain the repair performed. It should make clear whether the service treats a defect or a urethral injury.
Can modifier 50 be used for bilateral repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 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.
6,21553505,,Repair of urethra injury,A,,8.05,4.27,NA,4.27,,1.05,13.37,13.37,0,090,0.08,0.83,0.09,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21653510,,Repair of urethra injury,A,,10.69,5.20,NA,5.20,,1.36,17.25,17.25,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21753515,,Repair of urethra injury,A,,13.86,5.86,NA,5.86,,1.77,21.49,21.49,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21853520,,Repair of urethra defect,A,,9.24,4.90,NA,4.90,,1.20,15.34,15.34,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21953600,,Dilate urethra stricture,A,,1.18,1.40,,0.35,,0.15,2.73,1.68,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,22053601,,Dilate urethra stricture,A,,0.96,1.60,,0.35,,0.12,2.68,1.43,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,22153605,,Dilate urethra stricture,A,,1.25,0.26,NA,0.26,,0.16,1.67,1.67,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631