No office rate
51900 addresses a bladder-vaginal lesion. Choose 51940 when the operative diagnosis is bladder exstrophy rather than a lesion involving the bladder and vagina.
On this page
CMS RVU26D · Effective 2026-10-01
51940 Bladder repair Medicare reimbursement rates in Rhode Island
Reports surgical reconstruction of bladder exstrophy, including correction of the exposed bladder defect, with or without an osteotomy. Compare 51940 office and facility rates across CMS payment localities in Rhode Island.
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 51940 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1472.92
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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.
Urologic surgery
About 51940: Bladder exstrophy correction
Reports surgical reconstruction of bladder exstrophy, including correction of the exposed bladder defect, with or without an osteotomy.
This code describes operative correction of bladder exstrophy, a congenital defect in which the bladder is exposed through an opening in the lower abdominal wall. Reconstruction addresses the bladder defect and its associated abdominal-wall opening; an osteotomy may be part of the operation. Pediatric urologists typically perform the procedure in a hospital operating room, often as part of a planned reconstructive course.
Report 51940 when the operative service is correction of bladder exstrophy, rather than closure of a fistula or repair of a bladder-vaginal lesion. The operative report should identify the exstrophy and describe the reconstruction, including whether an osteotomy was performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and others are subject to the standard 50% reduction. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted. Modifier 50 is not appropriate for this procedure.
CMS billing rules for 51940
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU29.89 · 69%
- Practice expense (office) RVU9.88 · 23%
- Malpractice RVU3.85 · 9%
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.
51940 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
51920 is for closure of a bladder-uterus fistula. It does not describe reconstruction of bladder exstrophy.
No office rate
51925 concerns bladder repair associated with hysterectomy, rather than correction of a congenital bladder exstrophy defect.
Compare 51940 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1472.92
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 51940 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,099
- Code
- 51940
- Physician work
- 29.89
- Practice expense
- 9.88
- Malpractice
- 3.85
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 29.89 | × 1.019 | 30.4579 |
| Practice expense | 9.88 | × 1.033 | 10.2060 |
| Malpractice | 3.85 | × 0.892 | 3.4342 |
| Total RVUs | 44.0981 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1472.92
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 29.89 | 1.019 |
| Practice expense | 9.88 | 1.033 |
| Malpractice | 3.85 | 0.892 |
(29.89 × 1.019 + 9.88 × 1.033 + 3.85 × 0.892) × $33.4009 = $1472.92
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
51940 billing questions
When should 51940 be selected instead of a bladder fistula repair code?
Use 51940 for correction of bladder exstrophy. Codes for vesicovaginal or vesicouterine fistula repair address abnormal connections between organs, not the congenital exstrophy defect.
Does the code include an osteotomy when one is performed?
The service is described as correction of bladder exstrophy with or without osteotomy. Document whether an osteotomy was performed as part of the reconstruction.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does Medicare handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction, with payment at 50%.
Should modifier 50 be used?
No. Modifier 50 is inappropriate for this bladder exstrophy correction.
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.
6,09651900,,Repair bladder/vagina lesion,A,,14.26,6.22,NA,6.22,,1.83,22.31,22.31,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09751920,,Close bladder-uterus fistula,A,,13.07,5.99,NA,5.99,,1.68,20.74,20.74,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09851925,,Hysterectomy/bladder repair,A,,17.09,8.22,NA,8.22,,3.00,28.31,28.31,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,09951940,,Correction of bladder defect,A,,29.89,9.88,NA,9.88,,3.85,43.62,43.62,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,10051960,,Revision of bladder & bowel,A,,24.77,9.08,NA,9.08,,3.18,37.03,37.03,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,10151980,,Construct bladder opening,A,,12.26,5.54,NA,5.54,,1.57,19.37,19.37,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,10251990,,Laparo urethral suspension,A,,13.03,5.35,NA,5.35,,1.71,20.09,20.09,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537