No office rate
52443 identifies cystourethroscopic prostatic commissurotomy; 52450 describes transurethral incision of the prostate. Select based on the documented procedure, not just the indication.
On this page
CMS RVU26D · Effective 2026-10-01
52443 Prostate incision Medicare reimbursement rates in Vermont
Cystourethroscopic transurethral incision of the prostatic commissure to relieve urinary outlet obstruction is reported for the specific prostate incision performed. Compare 52443 office and facility rates across CMS payment localities in Vermont.
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 52443 in Vermont?
Vermont 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
$5839.01
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$164.40
1 of 1 localities have a supported rate.
Payment area: Vermont
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 52443: Transurethral prostatic commissurotomy
Cystourethroscopic transurethral incision of the prostatic commissure to relieve urinary outlet obstruction is reported for the specific prostate incision performed.
A urologist performs this endoscopic procedure through the urethra, using a cystourethroscope to incise the prostatic commissure and open the narrowed urinary passage. It is used for selected patients with prostatic obstruction causing lower urinary tract symptoms. The operative report should identify the prostatic incision performed and the endoscopic approach; it should not describe a different prostate procedure such as implant placement or tissue resection in its place.
Report the code for the documented commissurotomy rather than selecting a code solely from the diagnosis of benign prostatic enlargement. The service has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 52443
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- 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 RVU3.62 · 2%
- Practice expense (office) RVU172.69 · 98%
- Malpractice RVU0.46 · 0%
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.
52443 compared with similar codes
Office rates for Vermont, from the same CMS release.
Compare 52443 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
Vermont →
Office / nonfacility
$5839.01
Facility
$164.40
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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 52443 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,160
- Code
- 52443
- Physician work
- 3.62
- Practice expense
- 172.69
- Malpractice
- 0.46
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.62 | × 1.000 | 3.6200 |
| Practice expense | 172.69 | × 0.990 | 170.9631 |
| Malpractice | 0.46 | × 0.506 | 0.2328 |
| Total RVUs | 174.8159 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$5839.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.62 | 1 |
| Practice expense | 172.69 | 0.99 |
| Malpractice | 0.46 | 0.506 |
(3.62 × 1 + 172.69 × 0.99 + 0.46 × 0.506) × $33.4009 = $5839.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.62 | 1 |
| Practice expense | 1.08 | 0.99 |
| Malpractice | 0.46 | 0.506 |
(3.62 × 1 + 1.08 × 0.99 + 0.46 × 0.506) × $33.4009 = $164.40
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.
52443 billing questions
How is this different from code 52450?
Code 52443 identifies a cystourethroscopic prostatic commissurotomy. Code 52450 describes a transurethral incision of the prostate; use the code that matches the procedure documented.
Can a related endoscopy be reported on the same date?
When related endoscopies are performed together, endoscopy family pricing applies. The operative documentation should support each reported service.
Should modifier 50 be appended?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Is an assistant surgeon payable?
No. Medicare payment for an assistant at surgery is subject to a statutory restriction for this code.
What documentation supports reporting this code?
The operative report should identify the cystourethroscopic approach and the transurethral incision of the prostatic commissure. A diagnosis of urinary obstruction alone does not establish that this particular procedure was performed.
Does the code include same-day postoperative care?
Yes. The code has a 0-day global period, and same-day preoperative and postoperative care is included.
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.
6,15752402,,Cysto trurl rescj ejacul dux,A,,5.14,1.12,NA,1.12,,0.65,6.91,6.91,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,15852441,,Cysto insj trnsprstc 1 implt,A,,3.90,32.90,,1.13,,0.48,37.28,5.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,15952442,,Cysto ins trnsprstc implt ea,A,,0.98,24.77,,0.21,,0.13,25.88,1.32,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,16052443,,Cysto 1st trurl prst8 comis,A,,3.62,172.69,,1.08,,0.46,176.77,5.16,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,16152450,,Transurethral inc prostate,A,,7.59,4.53,NA,4.53,,0.99,13.11,13.11,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,16252500,,Trurl resection bladder neck,A,,5.85,3.94,NA,3.94,,0.76,10.55,10.55,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,1635250F,,Asthma discharge plan presnt,I,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817