Billing code 53855: Urethral stentMedicare rate & RVUs in Ohio
Reports placement of a prostatic urethral stent to maintain urine flow through an obstructed prostate, commonly for men with benign prostatic enlargement.
Medicare pays $602.41 for 53855 in the office in Ohio (Ohio). Which amount applies depends on the service address.
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 53855 covers
A urologist places a stent through the urethra into the prostatic segment to help keep the passage open when prostate enlargement obstructs urine flow. The service is used for men with lower urinary tract obstruction related to benign prostatic enlargement; cystoscopic placement is typical. It differs from procedures that ablate or remove prostate tissue because the treatment is stent placement rather than tissue destruction.
Report the insertion when the stent is placed, and document the indication, the device and its location, and the placement procedure. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery 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.
53855 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $602.41 | $70.88 |
How the 53855 rate is calculated
Each of 53855’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 · 53855
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.60Practice expense 17.77Malpractice 0.21
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53855
The CMS indicators that decide how 53855 is paid alongside other services.
CMS payment indicators · 53855
Urethral stent
| 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) | 0 | Not paid without supporting documentation. |
| 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
53855 without 51 · national office
$653.99
Urethral stent
53855-51 · Second procedure: 50%
$327.00
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%).
53855 compared with similar codes
Compare codes
53855 vs 53850 vs 53852 vs 53854: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 53850Prostate treatment
- Choose 53855 for prostatic urethral stent placement; 53850 describes microwave treatment of prostate tissue.
- 53852Prostate ablation
- 53852 represents radiofrequency needle treatment of prostate tissue, not stent insertion.
- 53854Prostate ablation
- 53854 describes water-vapor radiofrequency destruction of prostate tissue; 53855 is for placing a stent in the prostatic urethra.
53855 billing questions
How does this differ from prostate tissue treatment codes?
This code represents placement of a prostatic urethral stent to maintain an open channel. Codes such as 53850, 53852, and 53854 describe prostate tissue treatment methods instead.
What documentation supports the service?
Document the obstructive indication, the stent placed and its prostatic location, and the procedural details confirming insertion.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inapplicable because this is not a bilateral procedure.
Is same-day care included in the procedure?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
When is an assistant-at-surgery payable?
Only when medical necessity for the assistant is documented. Co-surgeons and team surgery are not permitted for this code.
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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