Billing code 53431: Urethral reconstructionMedicare rate & RVUs in Texas
Reports reconstructive surgery of the female urethra that also involves the bladder neck, such as repair of complex outlet damage or a congenital defect.
CMS doesn’t publish an office rate for 53431 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 53431 covers
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.
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 53431 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 | $1,036.33 |
| Beaumont | Unavailable | $1,001.44 |
| Brazoria | Unavailable | $1,014.19 |
| Dallas | Unavailable | $1,023.05 |
| Fort Worth | Unavailable | $1,021.68 |
| Galveston | Unavailable | $1,018.95 |
| Houston | Unavailable | $1,067.45 |
| Rest Of Texas | Unavailable | $1,008.97 |
How the 53431 rate is calculated
Each of 53431’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 · 53431
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 20.65Practice expense 7.55Malpractice 2.65
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53431
53431 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 53431
Urethral reconstruction
| 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 · 53431
Urethral reconstruction
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
53431 without 51 · national facility
$1,030.42
Urethral reconstruction
53431-51 · Second procedure: 50%
$515.21
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%).
53431 compared with similar codes
Compare codes
53431 vs 53430 vs 53410 vs 53440: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 53430Urethral repair
- 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.
- 53410Urethral reconstruction
- This code concerns female urethral and bladder neck reconstruction. Code 53410 describes reconstruction for male urethral anatomy.
- 53440Male sling
- Code 53440 is a male sling procedure for incontinence. It is not a substitute for documented female urethral and bladder neck reconstruction.
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 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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