Billing code 53275: Urethral repairMedicare rate & RVUs in Washington
Reports operative closure or reconstruction of a urethral defect, such as a defect left by injury or prior surgery, rather than lesion removal alone.
CMS doesn’t publish an office rate for 53275 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 53275 covers
This code is for operative repair of a defect in the urethra. A urologist typically performs the procedure in an operating room when the urethral wall needs surgical closure or reconstruction, including a defect associated with trauma or prior treatment. The operative report should identify the defect and describe the repair performed; a biopsy, lesion treatment, or removal procedure by itself is not this service.
Report the code for the urethral defect repair, not simply because the urethra was exposed or examined during another operation. Related postoperative visits are included for 10 days. When multiple procedures are performed in the same session, Medicare pays the highest-valued procedure in full and applies the standard reduction to the others. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are 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 53275 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $239.12 |
| Seattle (King Cnty) | Unavailable | $257.76 |
How the 53275 rate is calculated
Each of 53275’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 · 53275
RVUs × geographic indexes × conversion factor
Work4.46
4.46 RVUs× 1.000 GPCI
Practice expense2.06
2.06 RVUs× 1.000 GPCI
Malpractice0.62
0.62 RVUs× 1.000 GPCI
Adjusted RVUs
7.1400
Conversion factor
$33.4009
Medicare rate
$238.48
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 53275
53275 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 53275
Urethral repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 53275
Urethral repair
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
53275 without 51 · national facility
$238.48
Urethral repair
53275-51 · Second procedure: 50%
$119.24
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%).
53275 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 53200Urethral biopsy
- 53200 is for biopsy of urethral tissue. Use 53275 when the documented operative service repairs a defect rather than sampling tissue.
- 53220Urethral lesion treatment
- 53220 addresses treatment of a urethral lesion. Choose 53275 when the work is repair of a defect, not lesion-directed treatment.
- 53230Lesion excision
- 53230 is a urethral lesion removal code. It does not describe repair of a urethral defect.
- 53240Urethral surgery
- 53240 describes surgery for a urethral pouch. Use 53275 for repair of a urethral defect when the operative service is not pouch surgery.
53275 billing questions
When should this be reported instead of a urethral lesion procedure?
Report 53275 when the operative service repairs a urethral defect. A procedure directed at treating or removing a urethral lesion is represented by the applicable lesion code instead.
Does the code include related postoperative visits?
Yes. Related postoperative visits during the 10-day global period are included.
Can modifier 50 be used for a repair involving both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other procedures in the same session paid?
Medicare pays the highest-valued procedure in full and reduces the other procedures under the standard multiple-procedure rule.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
What documentation supports reporting the repair?
Document the location and nature of the urethral defect and the operative steps used to repair it. The note should distinguish repair from biopsy, lesion treatment, or excision.
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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