CPT code 50520: Fistula closure2026 Medicare rate & RVUs in Washington
Reports surgical closure of an abnormal tract connecting the kidney to the skin, such as a persistent nephrocutaneous fistula.
CMS doesn’t publish an office rate for 50520 in Washington.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 50520 covers
This service closes a fistulous tract between the kidney and the skin. A urologist typically performs the operation in a surgical setting when a persistent connection requires operative closure, including a tract that remains after nephrostomy drainage. The surgeon addresses the tract and its openings as needed to eliminate the abnormal communication.
Report 50520 when the documented connection is specifically between kidney and skin; the destination of the tract distinguishes it from closure of a fistula to a viscus. The operative report should establish the kidney-to-skin communication and describe its surgical closure. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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 may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
Where 50520 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $1,080.78 |
| Seattle (King Cnty) | Unavailable | $1,167.75 |
How the 50520 rate is calculated
Each of 50520’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 50520
RVUs × geographic indexes × conversion factor
Work18.41
18.41 RVUs× 1.000 GPCI
Practice expense9.47
9.47 RVUs× 1.000 GPCI
Malpractice4.91
4.91 RVUs× 1.000 GPCI
Adjusted RVUs
32.7900
Conversion factor
$33.4009
Medicare rate
$1,095.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50520
50520 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 50520
Fistula closure
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 50520
Fistula closure
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
50520 without 51 · national facility
$1,095.22
Fistula closure
50520-51 · Second procedure: 50%
$547.61
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
50520 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50525Fistula closure
- This code addresses a fistula involving a viscus. Choose 50520 when the documented tract connects the kidney to the skin.
- 50526Fistula closure
- This code is also for nephrovisceral fistula closure. The kidney-to-skin connection identifies 50520 instead.
- 50500Kidney repair
- 50500 is for repair of a kidney wound. Use 50520 when the operation closes a fistulous tract from the kidney to the skin.
50520 billing questions
When should 50520 be selected instead of 50525 or 50526?
Use 50520 for a fistulous connection between the kidney and skin. Codes 50525 and 50526 concern nephrovisceral fistulas, where the connection is to a viscus.
What documentation supports reporting 50520?
The record should identify the kidney-to-skin fistula and describe the operative closure. A skin opening or drainage alone does not establish that connection.
Can modifier 50 be used for bilateral closure?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
How does the 90-day global period affect postoperative care?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to a 50% 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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