Billing code 53605: Urethral dilationMedicare rate & RVUs in Ohio
Reports complicated dilation of a male urethral stricture using a sound or dilator, with documentation supporting the complexity of the procedure.
CMS doesn’t publish an office rate for 53605 in Ohio.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 53605 covers
A urologist dilates a narrowed segment of the male urethra by passing a sound or dilator. The procedure treats a urethral stricture and is reported with this code when the dilation is documented as complicated. It may be performed in an office or facility setting; the patient’s symptoms and the stricture’s location and extent help explain the clinical need for treatment.
Document the male anatomy, stricture, dilation technique, and circumstances supporting the complicated designation. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. 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. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
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.
53605 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $55.07 |
How the 53605 rate is calculated
Each of 53605’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 53605
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.25Practice expense 0.26Malpractice 0.16
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53605
The CMS indicators that decide how 53605 is paid alongside other services.
CMS payment indicators · 53605
Urethral dilation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
53605 without 51 · national facility
$55.78
Urethral dilation
53605-51 · Second procedure: 50%
$27.89
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
53605 compared with similar codes
Compare codes
53605 vs 53600 vs 53601 vs 53665: national Medicare rates
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How to choose
- 53600Urethral dilation
- Use 53600 for initial male urethral stricture dilation when the service is not documented as complicated. Code 53605 is the complicated-service choice.
- 53601Urethral dilation
- Code 53601 describes subsequent male stricture dilation when it is not complicated; 53605 identifies complicated dilation.
- 53665Urethral dilation
- Code 53665 is for male urethral dilation without an underlying pathology. Code 53605 requires a urethral stricture and a complicated dilation.
53605 billing questions
How is 53605 distinguished from 53600 or 53601?
Code 53605 is for complicated male urethral stricture dilation. Codes 53600 and 53601 describe male stricture dilation distinguished as initial or subsequent.
What documentation supports reporting 53605?
Document the male urethral stricture, the dilation performed, the technique, and the circumstances that make the procedure complicated.
Is same-day postoperative care separately reported?
Same-day preoperative and postoperative care is included in the 0-day global period.
Can modifier 50 be used?
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?
The highest-valued procedure is paid in full; other procedures performed in the same session are subject to the standard multiple procedure reduction.
Can an assistant 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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