No office rate
Use 53420 for the initial operation in the planned staged repair; use 53425 for its second-stage completion.
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CMS RVU26D · Effective 2026-10-01
53420 Urethral reconstruction Medicare reimbursement rates in Missouri
Reports the initial operation in a planned two-stage urethral reconstruction, typically for a urethral stricture or defect requiring staged repair. Compare 53420 office and facility rates across CMS payment localities in Missouri.
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 53420 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$728.31–$748.07
3 of 3 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.
Where 53420 pays more and less in Missouri
Urology surgery
About 53420: First-stage staged urethral reconstruction
Reports the initial operation in a planned two-stage urethral reconstruction, typically for a urethral stricture or defect requiring staged repair.
A urologist or reconstructive urologist performs the first operation in a planned two-stage urethral repair. In a Johanson-type approach, the diseased segment is opened and the urethral bed is prepared to heal before a later operation completes the reconstruction. This staged approach may be selected for complex urethral narrowing or tissue deficiency when immediate tubular reconstruction is not appropriate. The service is generally performed in a hospital or other surgical facility.
Report 53420 for the initial reconstructive operation, not the later completion stage. The operative report should establish the urethral problem, the staged plan, the work performed at this operation, and any tissue used. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Assistant-at-surgery payment is restricted; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53420
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.79 · 65%
- Practice expense (office) RVU5.98 · 26%
- Malpractice RVU1.91 · 8%
15
Medicare services in 2024 · #6077 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.
53420 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
53400 is for a one-stage urethral reconstruction. Choose 53420 when the operative plan divides reconstruction into stages and this is the first operation.
No office rate
53405 describes a staged urethral revision, while 53420 is for staged urethral reconstruction; the operative purpose distinguishes them.
Compare 53420 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$743.88
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$748.07
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$728.31
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53420 billing questions
How is 53420 different from 53425?
53420 represents the initial operation in the planned staged reconstruction. 53425 represents the later second-stage operation.
When would a single-stage urethral reconstruction code be considered instead?
Consider a single-stage code, such as 53400, when the surgeon completes the reconstruction in one operation rather than documenting a planned two-stage repair.
What documentation supports reporting 53420?
Document the urethral stricture or defect, why reconstruction is staged, the first-stage work performed, and the plan for the later stage.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect postoperative billing?
The 90-day global includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can an assistant or co-surgeon be billed?
CMS restricts assistant-at-surgery payment. Co-surgeon payment requires supporting documentation; team surgery is 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.
6,19253405,,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
6,19453415,,Reconstruction of urethra,A,,20.18,7.49,NA,7.49,,2.61,30.28,30.28,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19553420,,Reconstruct urethra stage 1,A,,14.79,5.98,NA,5.98,,1.91,22.68,22.68,0,090,0.08,0.83,0.09,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19653425,,Reconstruct urethra stage 2,A,,16.64,6.36,NA,6.36,,2.14,25.14,25.14,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19753430,,Reconstruction of urethra,A,,16.99,6.71,NA,6.71,,2.44,26.14,26.14,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19853431,,Reconstruct urethra/bladder,A,,20.65,7.55,NA,7.55,,2.65,30.85,30.85,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00