Billing code 53865: Prostate remodelingMedicare rate & RVUs in Ohio
A urologist inserts a temporary transprostatic remodeling device cystoscopically to reshape the prostatic urethra in patients treated for urinary obstruction.
Medicare pays $2,828.06 for 53865 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 53865 covers
A urologist passes a cystoscope through the urethra and places a temporary implant in the prostatic urethra. The device applies pressure that produces localized ischemic remodeling, creating channels through obstructing prostate tissue. The procedure is used for lower urinary tract symptoms related to benign prostatic enlargement and is performed in an outpatient procedural setting under cystoscopic visualization. The device is removed in a later procedure.
Report 53865 for the insertion procedure, supported by documentation of the indication, cystoscopic placement, and device insertion. Same-day preoperative and postoperative care is included in its 0-day global period. When related endoscopies are performed together, CMS endoscopy-family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay for an assistant at surgery, 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.
53865 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $2,828.06 | $142.97 |
How the 53865 rate is calculated
Each of 53865’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 · 53865
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.02Practice expense 89.00Malpractice 0.39
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53865
The CMS indicators that decide how 53865 is paid alongside other services.
CMS payment indicators · 53865
Prostate remodeling
| 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 | 3 | Endoscopy family rules apply. |
| 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
53865 without 51 · national office
$3,086.58
Prostate remodeling
53865-51 · Second procedure: 50%
$1,543.29
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%).
53865 compared with similar codes
Compare codes
53865 vs 52441 vs 53866 vs 53850 vs 53854: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 52441Prostate implant
- Use 53865 for temporary-device placement that reshapes the prostatic urethra through ischemic remodeling. Code 52441 describes placement of a permanent adjustable implant.
- 53866Device removal
- Code 53865 reports device insertion; code 53866 reports removal of the previously placed remodeling device.
- 53850Prostate treatment
- Code 53850 is microwave thermotherapy of the prostate. Code 53865 is cystoscopic placement of a temporary implant, not thermal treatment.
- 53854Prostate ablation
- Code 53854 treats prostate tissue with water-vapor ablation. Code 53865 uses a temporary implant to produce ischemic remodeling.
53865 billing questions
How does this differ from code 52441?
Code 53865 describes placement of a temporary device that reshapes the prostatic urethra through ischemic remodeling. Code 52441 is for insertion of a permanent adjustable transprostatic implant.
Is the later device removal included?
No. Removal is a separate procedure reported with code 53866, rather than part of the insertion service.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inappropriate for this service.
Can an assistant or co-surgeon be reported?
Medicare does not pay for an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another endoscopy is performed in the same session?
When related endoscopies are performed together, CMS endoscopy-family pricing applies. The claim should reflect the procedures actually performed and documented.
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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