No office rate
Both codes describe meatotomy. Choose 53025 for an infant and 53020 for a non-infant patient.
On this page
CMS RVU26D · Effective 2026-10-01
53020 Meatotomy Medicare reimbursement rates in Utah
A urologist incises a narrowed urethral opening to relieve meatal stenosis in a non-infant patient. Compare 53020 office and facility rates across CMS payment localities in Utah.
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 53020 in Utah?
Utah 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
$84.18
1 of 1 localities have a supported rate.
Payment area: Utah
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 procedure
About 53020: Non-infant urethral meatus incision
A urologist incises a narrowed urethral opening to relieve meatal stenosis in a non-infant patient.
This code represents a meatotomy: an incision at the urethral meatus to open a narrowed external opening, typically for meatal stenosis that obstructs or disrupts the urinary stream. A urologist commonly performs the procedure in an office or outpatient surgical setting. The code is for a non-infant patient; the infant-specific sibling is 53025.
Select the code when the treated narrowing is at the meatus, rather than a stricture farther along the urethra requiring urethrotomy. The record should identify the meatal narrowing and document the incision performed. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one 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 services are not paid, and co-surgeons and team surgery are not permitted.
CMS billing rules for 53020
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.73 · 67%
- Practice expense (office) RVU0.64 · 25%
- Malpractice RVU0.21 · 8%
166
Medicare services in 2024 · #4488 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.
53020 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
53020 incises the urethral meatus; 53000 describes an external urethrotomy for narrowing farther along the urethra.
No office rate
53020 treats meatal narrowing, while 53010 describes internal urethrotomy for a stricture within the urethra.
Compare 53020 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
Utah →
Office / nonfacility
Unavailable
Facility
$84.18
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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 53020 in Utah.
PPRRVU2026_Oct_nonQPP.csv
6,173
- Code
- 53020
- Physician work
- 1.73
- Practice expense
- 0.64
- Malpractice
- 0.21
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.73 | × 1.000 | 1.7300 |
| Practice expense | 0.64 | × 0.940 | 0.6016 |
| Malpractice | 0.21 | × 0.898 | 0.1886 |
| Total RVUs | 2.5202 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$84.18
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.73 | 1 |
| Practice expense | 0.64 | 0.94 |
| Malpractice | 0.21 | 0.898 |
(1.73 × 1 + 0.64 × 0.94 + 0.21 × 0.898) × $33.4009 = $84.18
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.
53020 billing questions
When should 53020 be chosen over 53025?
Use 53020 for a non-infant patient undergoing meatotomy. Code 53025 is the infant-specific sibling.
How does this differ from urethrotomy codes 53000 and 53010?
53020 treats narrowing at the urethral meatus. Codes 53000 and 53010 describe external and internal urethrotomy, respectively, for urethral narrowing beyond the meatal opening.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be billed?
Assistant-at-surgery services are not paid for this code. Co-surgeon and team-surgery billing are not permitted.
What same-day care is included?
The 0-day global period includes same-day preoperative and postoperative care.
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.
6,17052700,,Drainage of prostate abscess,A,,7.30,3.91,NA,3.91,,0.93,12.14,12.14,0,090,0.08,0.83,0.09,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17153000,,Incision of urethra,A,,2.27,1.60,NA,1.60,,0.28,4.15,4.15,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17253010,,Incision of urethra,A,,4.34,3.51,NA,3.51,,0.57,8.42,8.42,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17353020,,Incision of urethra,A,,1.73,0.64,NA,0.64,,0.21,2.58,2.58,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17453025,,Incision of urethra,A,,1.10,0.64,NA,0.64,,0.14,1.88,1.88,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17553040,,Drainage of urethra abscess,A,,6.39,3.64,NA,3.64,,0.82,10.85,10.85,0,090,0.08,0.83,0.09,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,17653060,,Drainage of urethra abscess,A,,2.61,2.65,,1.40,,0.45,5.71,4.46,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985