No office rate
Choose 52400 for congenital posterior urethral valves or obstruction; choose 52276 for incision of a urethral stricture.
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CMS RVU26D · Effective 2026-10-01
52400 Valve incision Medicare reimbursement rates in Wyoming
Endoscopic incision of congenital posterior urethral valves is reported when a urologist surgically relieves this outlet obstruction through the urethra. Compare 52400 office and facility rates across CMS payment localities in Wyoming.
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 52400 in Wyoming?
Wyoming 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
$418.73
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Urologic surgery
About 52400: Endoscopic incision of posterior urethral valves
Endoscopic incision of congenital posterior urethral valves is reported when a urologist surgically relieves this outlet obstruction through the urethra.
A urologist uses a cystoscope passed through the urethra to locate and incise congenital posterior urethral valves or a congenital posterior urethral obstruction. The procedure is commonly performed in a hospital or ambulatory surgical setting, often by a pediatric urologist for a child with bladder outlet obstruction. The operative service is the corrective incision, not cystoscopic inspection alone.
Report 52400 when the operative findings and documentation support treatment of a congenital posterior urethral valve or obstruction. The record should identify the congenital abnormality, describe the endoscopic findings and incision performed, and document the outcome. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 52400
- 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
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.47 · 66%
- Practice expense (office) RVU3.26 · 25%
- Malpractice RVU1.09 · 9%
82
Medicare services in 2024 · #5028 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.
52400 compared with similar codes
Office rates for Wyoming, from the same CMS release.
$307.17
52400 reports incision of a congenital posterior valve or obstruction. Code 52281 describes cystoscopic dilation of a urethral stricture or stenosis.
$214.03
52000 is diagnostic cystourethroscopy without the corrective valve incision. Report 52400 when the congenital obstruction is incised endoscopically.
Compare 52400 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
Wyoming** →
Office / nonfacility
Unavailable
Facility
$418.73
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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 52400 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
6,156
- Code
- 52400
- Physician work
- 8.47
- Practice expense
- 3.26
- Malpractice
- 1.09
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.47 | × 1.000 | 8.4700 |
| Practice expense | 3.26 | × 1.000 | 3.2600 |
| Malpractice | 1.09 | × 0.740 | 0.8066 |
| Total RVUs | 12.5366 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$418.73
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.47 | 1 |
| Practice expense | 3.26 | 1 |
| Malpractice | 1.09 | 0.74 |
(8.47 × 1 + 3.26 × 1 + 1.09 × 0.74) × $33.4009 = $418.73
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.
52400 billing questions
How does 52400 differ from direct vision internal urethrotomy?
52400 treats congenital posterior urethral valves or congenital posterior urethral obstruction. Direct vision internal urethrotomy, 52276, is used for a urethral stricture.
Can diagnostic cystoscopy be reported separately?
52400 describes the therapeutic incision performed through cystoscopic access. When the encounter includes the valve incision, do not treat the inspection needed to perform that incision as a separate diagnostic service.
Is modifier 50 appropriate for bilateral findings?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant surgeon or co-surgeon be paid?
Medicare does not pay an assistant at surgery for 52400. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
6,15352354,,Cystouretero w/biopsy,A,,7.80,2.15,NA,2.15,,1.02,10.97,10.97,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15452355,,Cystouretero w/excise tumor,A,,8.78,2.36,NA,2.36,,1.13,12.27,12.27,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15552356,,Cysto/uretero w/lithotripsy,A,,7.80,2.11,NA,2.11,,1.02,10.93,10.93,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15652400,,Cysto cgen post urtl valves,A,,8.47,3.26,NA,3.26,,1.09,12.82,12.82,0,090,0.08,0.83,0.09,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,15752402,,Cysto trurl rescj ejacul dux,A,,5.14,1.12,NA,1.12,,0.65,6.91,6.91,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,15852441,,Cysto insj trnsprstc 1 implt,A,,3.90,32.90,,1.13,,0.48,37.28,5.51,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,15952442,,Cysto ins trnsprstc implt ea,A,,0.98,24.77,,0.21,,0.13,25.88,1.32,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,