No office rate
Use 53510 for a simple male urethral injury repair. This code is for a complicated male repair, supported by the operative findings and work documented.
On this page
CMS RVU26D · Effective 2026-10-01
53515 Urethral repair Medicare reimbursement rates in Vermont
Reports operative reconstruction of a complicated urethral injury in a male patient, such as a substantial traumatic disruption requiring complex repair. Compare 53515 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 53515 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
No supported rate
Facility setting
$686.62
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 surgery
About 53515: Complicated male urethral injury repair
Reports operative reconstruction of a complicated urethral injury in a male patient, such as a substantial traumatic disruption requiring complex repair.
A urologist typically performs this repair in an operating room to reconstruct a complicated injury of the male urethra. A pelvic fracture-associated urethral disruption is one clinical context in which operative reconstruction may be considered. The work goes beyond a simple repair; the operative report should make the injury’s extent and the complexity of reconstruction clear.
Select this code for a complicated male urethral injury repair, rather than the simple male repair code. Document the injury site and extent, operative findings, and repair performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. A bilateral adjustment is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53515
- 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 RVU13.86 · 64%
- Practice expense (office) RVU5.86 · 27%
- Malpractice RVU1.77 · 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.
53515 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
This code is for complicated male urethral injury repair; 53505 is the corresponding complicated repair for female urethral anatomy.
No office rate
53502 describes simple female urethral injury repair. The patient anatomy and repair complexity distinguish it from this complicated male repair.
Compare 53515 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
Unavailable
Facility
$686.62
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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 53515 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,217
- Code
- 53515
- Physician work
- 13.86
- Practice expense
- 5.86
- Malpractice
- 1.77
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 13.86 | × 1.000 | 13.8600 |
| Practice expense | 5.86 | × 0.990 | 5.8014 |
| Malpractice | 1.77 | × 0.506 | 0.8956 |
| Total RVUs | 20.5570 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$686.62
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 13.86 | 1 |
| Practice expense | 5.86 | 0.99 |
| Malpractice | 1.77 | 0.506 |
(13.86 × 1 + 5.86 × 0.99 + 1.77 × 0.506) × $33.4009 = $686.62
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.
53515 billing questions
How does this differ from 53510?
53515 is for a complicated male urethral injury repair; 53510 is the simple male repair. The operative documentation should support the complexity distinction.
Can modifier 50 be used for a bilateral repair?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Are related postoperative visits separately reported?
The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
What documentation supports reporting the complicated repair?
Record the injury location and extent, operative findings, and repair performed so the complexity is distinguishable from a simple male repair.
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.
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.
6,21453502,,Repair of urethra injury,A,,8.05,4.28,NA,4.28,,1.05,13.38,13.38,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21553505,,Repair of urethra injury,A,,8.05,4.27,NA,4.27,,1.05,13.37,13.37,0,090,0.08,0.83,0.09,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21653510,,Repair of urethra injury,A,,10.69,5.20,NA,5.20,,1.36,17.25,17.25,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21753515,,Repair of urethra injury,A,,13.86,5.86,NA,5.86,,1.77,21.49,21.49,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21853520,,Repair of urethra defect,A,,9.24,4.90,NA,4.90,,1.20,15.34,15.34,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,21953600,,Dilate urethra stricture,A,,1.18,1.40,,0.35,,0.15,2.73,1.68,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,22053601,,Dilate urethra stricture,A,,0.96,1.60,,0.35,,0.12,2.68,1.43,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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