Billing code 53449: Sphincter repairMedicare rate & RVUs in Washington
Reports operative repair of the urinary sphincter, such as surgical correction of a sphincter defect causing urinary leakage.
CMS doesn’t publish an office rate for 53449 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 53449 covers
A urologist, often one specializing in reconstructive surgery, reports this service when an operation directly repairs the urinary sphincter. It is distinct from placing or exchanging an artificial urinary sphincter and from urethral reconstruction. The operative report should identify the sphincter defect and describe the repair performed; the service is generally provided in an operating-room setting.
Report the code when the documented work is sphincter repair, rather than device insertion, removal, or replacement. The major-surgery global period includes 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 the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; 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 53449 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $562.38 |
| Seattle (King Cnty) | Unavailable | $607.36 |
How the 53449 rate is calculated
Each of 53449’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 · 53449
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 10.30Practice expense 5.12Malpractice 1.33
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 53449
53449 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 53449
Sphincter repair
| 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 · 53449
Sphincter repair
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
53449 without 51 · national facility
$559.47
Sphincter repair
53449-51 · Second procedure: 50%
$279.74
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%).
53449 compared with similar codes
Compare codes
53449 vs 53445 vs 53447 vs 53448: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 53445Artificial sphincter
- Use 53449 for operative repair of the urinary sphincter; use 53445 when inserting an artificial urinary sphincter.
- 53447Sphincter replacement
- Code 53447 describes removal and replacement of an artificial urinary sphincter. It is not the code for repairing the sphincter itself.
- 53448Sphincter replacement
- Code 53448 covers removal and replacement of a urinary sphincter component; 53449 represents repair rather than component exchange.
53449 billing questions
How is this different from code 53445?
This code is for operative repair of the urinary sphincter. Code 53445 is for inserting an artificial urinary sphincter.
Can device replacement be reported as sphincter repair?
No. Removal and replacement of an artificial urinary sphincter or its component are represented by separate codes, including 53447 and 53448.
Should modifier 50 be used for repair on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports reporting this code?
Document the urinary sphincter defect and the operative repair performed. The record should make clear that the service was repair, not device insertion, removal, or replacement.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session 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 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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