53415 Urethroplasty Medicare reimbursement rates in Massachusetts

A reconstructive urologist uses this code for a one-stage urethroplasty performed through a transpubic or perineal approach to address urethral stricture or atresia. The operation restores urethral continuity or patency; it is distinct from a planned two-stage reconstruction. These repairs are generally performed in a hospital operating room, often for complex narrowing or obliteration that requires an open reconstructive approach.

Select the code from the operative report’s documented approach, one-stage plan, and urethral condition—not simply from the diagnosis of stricture. The note should describe the reconstruction and the route used. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.