No office rate
54322 is for a distal penile hypospadias presentation. Use 54326 when the urethral opening is perineal.
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CMS RVU26D · Effective 2026-10-01
54326 Urethral reconstruction Medicare reimbursement rates in Vermont
Reports one-stage reconstruction for severe perineal hypospadias, when the surgeon creates a urethral channel from the perineal opening toward the glans. Compare 54326 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 54326 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
$810.35
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 54326: One-stage perineal hypospadias reconstruction
Reports one-stage reconstruction for severe perineal hypospadias, when the surgeon creates a urethral channel from the perineal opening toward the glans.
This code describes a one-stage operation for severe hypospadias in which the urethral opening is in the perineum. The surgeon reconstructs the urethral passage, using extensive dissection and mobilization of the urethral plate. A urologist typically performs the procedure in an operating room, often for a child with a congenital urethral opening well proximal to the penile shaft. The operative report should identify the original meatus location and describe the reconstruction performed.
Choose this code for the perineal presentation, rather than a repair classified by a distal or proximal penile meatus. Documentation should support the anatomy and the extent of reconstruction. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Assistant-at-surgery services may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 54326
- 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 RVU16.59 · 65%
- Practice expense (office) RVU6.66 · 26%
- Malpractice RVU2.13 · 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.
54326 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
54324 addresses proximal penile hypospadias; 54326 identifies the more proximal, perineal presentation.
No office rate
54344 is for correction of a hypospadias repair complication, not the primary perineal reconstruction reported with 54326.
No office rate
54352 is for revision of a prior hypospadias repair. Use 54326 for the primary one-stage perineal reconstruction.
Compare 54326 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
$810.35
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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 54326 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,280
- Code
- 54326
- Physician work
- 16.59
- Practice expense
- 6.66
- Malpractice
- 2.13
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.59 | × 1.000 | 16.5900 |
| Practice expense | 6.66 | × 0.990 | 6.5934 |
| Malpractice | 2.13 | × 0.506 | 1.0778 |
| Total RVUs | 24.2612 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$810.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.59 | 1 |
| Practice expense | 6.66 | 0.99 |
| Malpractice | 2.13 | 0.506 |
(16.59 × 1 + 6.66 × 0.99 + 2.13 × 0.506) × $33.4009 = $810.35
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.
54326 billing questions
How is this code distinguished from 54324?
54326 is selected for perineal hypospadias. Code 54324 is for a proximal penile presentation; document the location of the urethral opening.
What documentation supports reporting 54326?
The operative report should establish that the meatus is perineal and describe the extensive dissection, urethral plate mobilization, and reconstruction performed.
Are related postoperative visits separately reported during the global period?
The 90-day global period includes related postoperative care, as well as the day-before preoperative visit.
How is 54326 treated when another procedure is performed in the same session?
The highest-valued procedure is paid in full, with other procedures subject to the standard multiple procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation.
Can 54326 be reported for a repair of a prior hypospadias operation?
Use a code for revision or repair of a complication when the operative purpose is to address a prior repair, rather than to perform the primary perineal reconstruction represented by 54326.
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.
6,27754318,,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
6,27954324,,Reconstruction of urethra,A,,17.11,6.74,NA,6.74,,2.19,26.04,26.04,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28054326,,Reconstruction of urethra,A,,16.59,6.66,NA,6.66,,2.13,25.38,25.38,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28154328,,Revise penis/urethra,A,,16.47,6.64,NA,6.64,,2.12,25.23,25.23,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28254332,,Revise penis/urethra,A,,17.91,6.93,NA,6.93,,2.31,27.15,27.15,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,28354336,,Revise penis/urethra,A,,21.08,8.08,NA,8.08,,2.71,31.87,31.87,0,090,0.10,0.80,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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