No office rate
Both address urethral or bladder-neck reconstruction, but 51820 represents the complicated service; 51800 is the less complex related code.
On this page
CMS RVU26D · Effective 2026-10-01
51820 Outlet reconstruction Medicare reimbursement rates in Massachusetts
Complex reconstructive surgery of the urethra or bladder neck, reported when operative repair goes beyond a straightforward revision of these structures. Compare 51820 office and facility rates across CMS payment localities in Massachusetts.
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 51820 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$981.92–$1041.43
2 of 2 localities have a supported rate.
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 51820: Complicated urethral or bladder-neck reconstruction
Complex reconstructive surgery of the urethra or bladder neck, reported when operative repair goes beyond a straightforward revision of these structures.
A urologist performs this reconstructive operation to correct a complex abnormality involving the urethra or bladder neck. It may be used for congenital or acquired structural problems, including defects encountered after prior surgery. The surgeon reshapes or reconstructs the affected outlet anatomy in an operating room; this is distinct from simply closing a bladder wound or supporting pelvic organs for prolapse or incontinence.
Report the code when the operative work supports a complicated reconstructive repair, rather than the less complex related procedure. The operative note should identify the affected anatomy, the underlying problem, and the reconstructive work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 51820
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU19.10 · 65%
- Practice expense (office) RVU7.62 · 26%
- Malpractice RVU2.47 · 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.
51820 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
51860 is for simple closure of a bladder wound. Choose 51820 when the operation reconstructs a complex urethral or bladder-neck abnormality instead.
No office rate
51865 concerns complicated repair of a bladder wound, while 51820 describes complicated reconstruction of the urethra or bladder neck.
No office rate
51845 is a bladder-neck suspension procedure for stress incontinence; 51820 addresses reconstructive correction of abnormal outlet anatomy.
Compare 51820 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$1041.43
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$981.92
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51820 billing questions
How does this differ from 51800?
51820 is for the complicated reconstructive service. Use 51800 for the less complex related urethral or bladder-neck reconstruction when the operative work supports that level.
Should modifier 50 be appended for bilateral work?
CMS prices this code as bilateral. Modifier 50 does not increase payment.
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.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
What should the operative note establish?
Document the urethral or bladder-neck abnormality, the anatomy addressed, and the reconstructive steps that support a complicated repair.
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.
6,08651797,TC,Intraabdominal pressure test,A,,0.00,3.46,,3.46,NA,0.00,3.46,3.46,1,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,02,0,99,0.00,0.00,0.00
6,08751798,,Us urine capacity measure,A,,0.00,0.36,,0.36,NA,0.02,0.38,0.38,3,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,08851800,,Revision of bladder/urethra,A,,18.42,7.09,NA,7.09,,2.37,27.88,27.88,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,08951820,,Revision of urinary tract,A,,19.10,7.62,NA,7.62,,2.47,29.19,29.19,0,090,0.08,0.83,0.09,2,2,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09051840,,Attach bladder/urethra,A,,11.08,5.92,NA,5.92,,1.63,18.63,18.63,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09151841,,Attach bladder/urethra,A,,13.34,6.46,NA,6.46,,1.71,21.51,21.51,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09251845,,Repair bladder neck,A,,9.90,4.70,NA,4.70,,1.28,15.88,15.88,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00