No office rate
Both address female urethral reconstruction. This code requires reconstruction that includes the bladder neck; 53430 is used when the documented reconstruction does not include that work.
On this page
CMS RVU26D · Effective 2026-10-01
53431 Urethral reconstruction Medicare reimbursement rates in Rhode Island
Reports reconstructive surgery of the female urethra that also involves the bladder neck, such as repair of complex outlet damage or a congenital defect. Compare 53431 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 53431 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
$1042.29
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.
Urology surgery
About 53431: Female urethral and bladder neck reconstruction
Reports reconstructive surgery of the female urethra that also involves the bladder neck, such as repair of complex outlet damage or a congenital defect.
This operation rebuilds the female urethral outlet and includes reconstruction of the bladder neck. A urologist or reconstructive urologist typically performs it in an operating room, often for significant anatomic damage, a congenital defect, or another condition requiring restoration of both structures. The documented operative work should show that bladder neck reconstruction is part of the procedure, not merely urethral repair or treatment of incontinence by a sling or artificial sphincter.
Choose this code when the operative report supports reconstruction of the female urethra that includes the bladder neck; urethral reconstruction without that work is represented by a different code. Document the anatomy, defect, and reconstructive steps. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same 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. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53431
- 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 RVU20.65 · 67%
- Practice expense (office) RVU7.55 · 24%
- Malpractice RVU2.65 · 9%
18
Medicare services in 2024 · #5985 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.
53431 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
This code concerns female urethral and bladder neck reconstruction. Code 53410 describes reconstruction for male urethral anatomy.
No office rate
Code 53440 is a male sling procedure for incontinence. It is not a substitute for documented female urethral and bladder neck reconstruction.
Compare 53431 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
$1042.29
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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 53431 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
6,198
- Code
- 53431
- Physician work
- 20.65
- Practice expense
- 7.55
- Malpractice
- 2.65
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 20.65 | × 1.019 | 21.0423 |
| Practice expense | 7.55 | × 1.033 | 7.7991 |
| Malpractice | 2.65 | × 0.892 | 2.3638 |
| Total RVUs | 31.2053 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1042.29
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 20.65 | 1.019 |
| Practice expense | 7.55 | 1.033 |
| Malpractice | 2.65 | 0.892 |
(20.65 × 1.019 + 7.55 × 1.033 + 2.65 × 0.892) × $33.4009 = $1042.29
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.
53431 billing questions
How do I distinguish this code from 53430?
Use this code when the female urethral reconstruction also includes bladder neck reconstruction. Use 53430 for female urethral reconstruction when the documented work does not include the bladder neck.
Does treatment of incontinence alone support this code?
No. The operative documentation must support reconstruction of the female urethra and bladder neck. A sling or artificial urinary sphincter procedure is a different service.
What documentation supports reporting it?
Document the urethral and bladder neck anatomy being reconstructed, the defect or condition addressed, and the operative steps performed on both structures.
Can modifier 50 be used?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How does the global period affect postoperative visits?
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?
Assistant-at-surgery payment may be made. 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.
6,19553420,,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
6,19953440,,Male sling procedure,A,,13.03,5.70,NA,5.70,,1.67,20.40,20.40,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20053442,,Remove/revise male sling,A,,13.15,6.61,NA,6.61,,1.69,21.45,21.45,0,090,0.08,0.83,0.09,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,20153444,,Insert tandem cuff,A,,13.84,5.85,NA,5.85,,1.77,21.46,21.46,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,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