No office rate
50130 includes removal of a calculus through open pyelotomy. Choose 50120 when the service is pyelotomy with exploration and the operative report does not document stone removal.
On this page
CMS RVU26D · Effective 2026-10-01
50130 Stone removal Medicare reimbursement rates in Tennessee
Reports open surgical access to the renal pelvis to remove a calculus, typically when the operative plan calls for direct pyelotomy. Compare 50130 office and facility rates across CMS payment localities in Tennessee.
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 50130 in Tennessee?
Tennessee 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
$868.37
1 of 1 localities have a supported rate.
Payment area: Tennessee
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 50130: Open renal pelvis stone removal
Reports open surgical access to the renal pelvis to remove a calculus, typically when the operative plan calls for direct pyelotomy.
A urologist opens the renal pelvis surgically and removes a calculus. The service is performed in an operating room, generally in a hospital facility, when the planned treatment requires direct open access to the collecting system. The operative report should establish the pyelotomy approach and removal of the stone; exploration alone or drainage without stone removal describes a different service.
Report this code for the open stone-removal procedure, with documentation identifying the treated side, operative approach, and calculus removal. It has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. 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 50% reduction. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 50130
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU18.35 · 66%
- Practice expense (office) RVU7.02 · 25%
- Malpractice RVU2.36 · 9%
33
Medicare services in 2024 · #5601 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.
50130 compared with similar codes
Office rates for Tennessee, from the same CMS release.
No office rate
50125 describes pyelotomy with creation of drainage through a pyelostomy. This code identifies open pyelotomy with calculus removal.
No office rate
50080 uses a percutaneous approach for stone removal. This code is for direct open access to the renal pelvis.
$704.71
50590 describes extracorporeal shock-wave treatment of a kidney stone. This code represents open surgical removal through pyelotomy.
Compare 50130 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
Tennessee →
Office / nonfacility
Unavailable
Facility
$868.37
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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 50130 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,880
- Code
- 50130
- Physician work
- 18.35
- Practice expense
- 7.02
- Malpractice
- 2.36
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.35 | × 1.000 | 18.3500 |
| Practice expense | 7.02 | × 0.909 | 6.3812 |
| Malpractice | 2.36 | × 0.537 | 1.2673 |
| Total RVUs | 25.9985 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$868.37
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.35 | 1 |
| Practice expense | 7.02 | 0.909 |
| Malpractice | 2.36 | 0.537 |
(18.35 × 1 + 7.02 × 0.909 + 2.36 × 0.537) × $33.4009 = $868.37
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.
50130 billing questions
How is this distinguished from 50120?
Use 50130 when the open pyelotomy includes removal of a calculus. Code 50120 describes pyelotomy with exploration rather than the documented stone-removal service.
Can stone removal and pyelostomy drainage be reported together?
Code 50125 describes pyelotomy with drainage by pyelostomy. Select the code that matches the documented operative service; do not report drainage as a substitute for documented calculus removal.
How is bilateral stone removal reported?
For a bilateral procedure, modifier 50 is paid at 150% under the CMS facts for this code. The operative documentation should establish treatment of both sides.
Does the global period include routine postoperative care?
Yes. 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.
What happens when other 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 of 50%.
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.
5,8775010F,,Macul result phy/qhp mng dm,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,87850120,,Pyelotomy w/exploration,A,,16.78,6.61,NA,6.61,,2.16,25.55,25.55,0,090,0.08,0.83,0.09,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,87950125,,Pyelotomy w/drg pyelostomy,A,,17.37,6.82,NA,6.82,,2.22,26.41,26.41,0,090,0.08,0.83,0.09,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,88050130,,Pyelotomy w/removal calculus,A,,18.35,7.02,NA,7.02,,2.36,27.73,27.73,0,090,0.08,0.83,0.09,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,8815015F,,Doc fx & test/txmnt for op,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,88250200,,Renal biopsy perq,A,,2.32,12.17,,0.74,,0.24,14.73,3.30,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,88350205,,Renal bx surg exposure kdn,A,,11.98,6.39,NA,6.39,,2.98,21.35,21.35,0,090,0.08,0.83,0.09,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780