$161.10–$184.25
53200 reports urethral biopsy for diagnostic sampling. Use 53220 when the procedure treats a urethral caruncle by excision or fulguration.
On this page
CMS RVU26D · Effective 2026-10-01
53220 Urethral lesion treatment Medicare reimbursement rates in Virginia
Reports surgical treatment of a urethral caruncle by excision or fulguration, typically performed by a urologist for a symptomatic lesion. Compare 53220 office and facility rates across CMS payment localities in Virginia.
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 53220 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$404.11–$456.96
2 of 2 localities have a supported rate.
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 53220: Urethral caruncle excision or fulguration
Reports surgical treatment of a urethral caruncle by excision or fulguration, typically performed by a urologist for a symptomatic lesion.
This code describes excision or fulguration of a urethral caruncle, a localized lesion at the urethral opening that may cause bleeding, irritation, or urinary symptoms. A urologist typically performs the procedure in a surgical or procedural setting. The operative approach depends on the lesion and the planned treatment; the record should identify the caruncle and document the technique performed.
Report the code for treatment of a caruncle, not merely diagnostic tissue sampling. The operative note should support the lesion treated and the work performed. CMS assigns a 90-day global period, which includes 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. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 53220
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.44 · 60%
- Practice expense (office) RVU4.05 · 33%
- Malpractice RVU0.96 · 8%
51
Medicare services in 2024 · #5348 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.
53220 compared with similar codes
Office rates for Virginia, from the same CMS release.
$207.83–$238.66
53260 is used for treatment of a urethral lesion other than a caruncle. 53220 identifies treatment of a caruncle.
$225.03–$258.87
53265 is used for treatment of a urethral lesion other than a caruncle. 53220 identifies treatment of a caruncle.
Compare 53220 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$456.96
Virginia →
Office / nonfacility
Unavailable
Facility
$404.11
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53220 billing questions
When is 53220 appropriate instead of a urethral biopsy?
Use 53220 when the service treats a urethral caruncle by excision or fulguration. Code 53200 describes biopsy for diagnostic tissue sampling.
How does 53220 differ from 53260 or 53265?
53220 is for treatment of a urethral caruncle. Codes 53260 and 53265 address other urethral lesions, with the applicable code depending on the lesion and treatment extent.
Does the 90-day global include related postoperative care?
Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code.
When is an assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
6,17953200,,Biopsy of urethra,A,,2.53,2.06,,0.92,,0.38,4.97,3.83,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18053210,,Removal of urethra,A,,13.38,5.73,NA,5.73,,1.72,20.83,20.83,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18153215,,Removal of urethra,A,,16.43,6.37,NA,6.37,,2.13,24.93,24.93,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18253220,,Treatment of urethra lesion,A,,7.44,4.05,NA,4.05,,0.96,12.45,12.45,0,090,0.08,0.83,0.09,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18353230,,Removal of urethra lesion,A,,10.18,4.94,NA,4.94,,1.47,16.59,16.59,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18453235,,Removal of urethra lesion,A,,10.72,5.21,NA,5.21,,1.36,17.29,17.29,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18553240,,Surgery for urethra pouch,A,,6.90,3.95,NA,3.95,,0.89,11.74,11.74,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00