Billing code 51920: Fistula repairMedicare rate & RVUs in Texas
Reports operative closure of an abnormal connection between the bladder and uterus, such as a fistula following cesarean delivery or pelvic surgery.
CMS doesn’t publish an office rate for 51920 in Texas.
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 51920 covers
This code is for surgical closure of a vesicouterine fistula, an abnormal passage connecting the bladder and uterus. These fistulas may follow cesarean delivery or other pelvic surgery and can cause urine to pass through the uterus. A urologist or gynecologic surgeon may perform the repair in a hospital or other surgical setting. The operative report should establish that the communication is between the bladder and uterus and describe its closure.
Select this code for the vesicouterine fistula repair, rather than a repair directed at a bladder-vaginal fistula or a nonfistulous bladder defect. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this anatomy. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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.
Where 51920 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $698.81 |
| Beaumont | Unavailable | $670.74 |
| Brazoria | Unavailable | $682.08 |
| Dallas | Unavailable | $687.90 |
| Fort Worth | Unavailable | $686.62 |
| Galveston | Unavailable | $685.18 |
| Houston | Unavailable | $715.93 |
| Rest Of Texas | Unavailable | $677.09 |
How the 51920 rate is calculated
Each of 51920’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 · 51920
RVUs × geographic indexes × conversion factor
Work13.07
13.07 RVUs× 1.000 GPCI
Practice expense5.99
5.99 RVUs× 1.000 GPCI
Malpractice1.68
1.68 RVUs× 1.000 GPCI
Adjusted RVUs
20.7400
Conversion factor
$33.4009
Medicare rate
$692.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 51920
51920 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 51920
Fistula repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 51920
Fistula repair
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
51920 without 51 · national facility
$692.73
Fistula repair
51920-51 · Second procedure: 50%
$346.37
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%).
51920 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 51900Fistula repair
- This code addresses a bladder-to-uterus fistula. Code 51900 is for a bladder-to-vagina fistula repaired through a vaginal approach.
- 51925Fistula repair
- Code 51925 describes bladder-vaginal fistula repair with hysterectomy. Use this code for a bladder-to-uterus fistula, based on the documented anatomy and operation.
- 51940Bladder repair
- Code 51940 concerns correction of a bladder defect, not closure of a fistulous connection between the bladder and uterus.
51920 billing questions
How is this different from a vesicovaginal fistula repair?
Use this code when the fistula connects the bladder and uterus. A bladder-to-vagina fistula is a different anatomic repair; the approach and any accompanying procedure also matter when selecting its code.
Does this code include a hysterectomy?
The code identifies closure of a vesicouterine fistula. Document any hysterectomy separately as a distinct performed service and select its code based on the actual operation.
Can modifier 50 be used?
No. Bilateral adjustment is inappropriate for this code’s descriptor and anatomy.
What documentation supports reporting this code?
The operative report should identify the bladder-to-uterus fistula and describe the surgical closure. Include the clinical context, such as a fistula following pelvic surgery, when documented.
How are other procedures in the same session paid?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures in the session are subject to reduction. Related postoperative care is included in this code’s 90-day global period.
May 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.
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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