No office rate
Both are in the hypospadias reconstruction family. Choose between them by matching the documented operative circumstances to each code’s full CPT criteria.
On this page
CMS RVU26D · Effective 2026-10-01
54312 Urethral reconstruction Medicare reimbursement rates in Utah
Reports operative reconstruction of the urethra for hypospadias when the documented repair meets this code’s specific anatomic and procedural criteria. Compare 54312 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 54312 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
$722.19
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.
Urologic surgery
About 54312: Hypospadias urethral reconstruction
Reports operative reconstruction of the urethra for hypospadias when the documented repair meets this code’s specific anatomic and procedural criteria.
This code is used for operative urethral reconstruction in a patient with hypospadias, a congenital condition in which the urethral opening is not at the usual position. The surgeon reconstructs the urethral passage and creates or relocates its opening as part of the repair. Pediatric urologists and other surgeons with appropriate reconstructive expertise typically perform these procedures in an operating room, often in a hospital or ambulatory surgery center.
Select this code from the operative report’s documented anatomy, extent of reconstruction, and technique, using the full CPT descriptor to distinguish it from other hypospadias repair codes. Documentation should identify the urethral defect, operative steps, and any associated reconstruction. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur 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 code. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54312
- 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 RVU14.15 · 64%
- Practice expense (office) RVU6.21 · 28%
- Malpractice RVU1.82 · 8%
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.
54312 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
This is a staged-reconstruction option in the same family. The operative plan and stage documented determine whether it applies instead.
No office rate
This is another staged-reconstruction option. Distinguish it by the stage and procedure documented, rather than by the general urethral reconstruction label.
Compare 54312 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
$722.19
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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 54312 in Utah.
PPRRVU2026_Oct_nonQPP.csv
6,275
- Code
- 54312
- Physician work
- 14.15
- Practice expense
- 6.21
- Malpractice
- 1.82
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.15 | × 1.000 | 14.1500 |
| Practice expense | 6.21 | × 0.940 | 5.8374 |
| Malpractice | 1.82 | × 0.898 | 1.6344 |
| Total RVUs | 21.6218 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$722.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.15 | 1 |
| Practice expense | 6.21 | 0.94 |
| Malpractice | 1.82 | 0.898 |
(14.15 × 1 + 6.21 × 0.94 + 1.82 × 0.898) × $33.4009 = $722.19
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.
54312 billing questions
How should I distinguish this code from other hypospadias repairs?
Use the full CPT descriptor and operative documentation to match the repair’s anatomy and technique. The general CMS short descriptor alone does not distinguish the reconstruction codes in this family.
Is related postoperative care separately reported?
Related postoperative care during the 90-day global period is included. The global period also includes the day-before preoperative visit.
Can I append modifier 50 for bilateral repair?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can 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.
What happens if another procedure is performed in the same session?
CMS pays the highest-valued procedure in full and applies the standard multiple-procedure reduction to the others.
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.
6,27254300,,Revision of penis,A,,10.92,5.27,NA,5.27,,1.43,17.62,17.62,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27354304,,Revision of penis,A,,12.95,5.63,NA,5.63,,1.66,20.24,20.24,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27454308,,Reconstruction of urethra,A,,12.30,5.55,NA,5.55,,1.58,19.43,19.43,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27554312,,Reconstruction of urethra,A,,14.15,6.21,NA,6.21,,1.82,22.18,22.18,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27654316,,Reconstruction of urethra,A,,17.60,6.87,NA,6.87,,2.26,26.73,26.73,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27754318,,Reconstruction of urethra,A,,12.12,5.70,NA,5.70,,1.56,19.38,19.38,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,27854322,,Reconstruction of urethra,A,,13.63,5.72,NA,5.72,,1.75,21.10,21.10,0,090,0.10,0.80,0.10,2,0,2,0,0,9,,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