$227.47
Both describe urethral lesion destruction. Choose 53260 for simple treatment and 53265 when the destruction is extensive.
On this page
CMS RVU26D · Effective 2026-10-01
53260 Lesion destruction Medicare reimbursement rates in Wyoming
Destruction of a simple urethral lesion, such as a condyloma or papilloma, is reported when the lesion is treated rather than excised. Compare 53260 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 53260 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
$210.03
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$161.93
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.
Urology
About 53260: Simple urethral lesion destruction
Destruction of a simple urethral lesion, such as a condyloma or papilloma, is reported when the lesion is treated rather than excised.
Code 53260 describes destruction of a simple lesion arising in the urethra, such as a condyloma or papilloma. A urologist typically performs the treatment in an office or facility setting. The code fits a limited treatment; extensive urethral lesion destruction belongs to the corresponding extensive service, while surgical removal of lesion tissue is a different service.
Select the code from the procedure performed and documented, including the lesion’s urethral location, extent, and treatment method. The procedure has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 53260
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- 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 RVU2.95 · 46%
- Practice expense (office) RVU3.02 · 47%
- Malpractice RVU0.43 · 7%
103
Medicare services in 2024 · #4860 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.
53260 compared with similar codes
Office rates for Wyoming, from the same CMS release.
No office rate
53230 is for surgical excision of a urethral lesion; 53260 is for destroying a simple lesion rather than removing it.
No office rate
53220 is specific to treatment of a urethral caruncle. Code 53260 addresses simple destruction of other urethral lesions.
Compare 53260 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
$210.03
Facility
$161.93
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 53260 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
6,187
- Code
- 53260
- Physician work
- 2.95
- Practice expense
- 3.02
- Malpractice
- 0.43
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.95 | × 1.000 | 2.9500 |
| Practice expense | 3.02 | × 1.000 | 3.0200 |
| Malpractice | 0.43 | × 0.740 | 0.3182 |
| Total RVUs | 6.2882 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$210.03
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.95 | 1 |
| Practice expense | 3.02 | 1 |
| Malpractice | 0.43 | 0.74 |
(2.95 × 1 + 3.02 × 1 + 0.43 × 0.74) × $33.4009 = $210.03
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.95 | 1 |
| Practice expense | 1.58 | 1 |
| Malpractice | 0.43 | 0.74 |
(2.95 × 1 + 1.58 × 1 + 0.43 × 0.74) × $33.4009 = $161.93
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.
53260 billing questions
How do I choose between 53260 and 53265?
Use 53260 for simple urethral lesion destruction and 53265 for extensive destruction. Document the treated lesion and the extent of the work supporting that level.
When is excision code 53230 a better fit?
Use 53230 when the urethral lesion is surgically excised. Code 53260 describes destruction rather than removal of the lesion.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in 53260.
Can modifier 50 be used for lesions on both sides?
No. The descriptor or anatomy makes bilateral adjustment inappropriate for this code.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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.
6,18453235,,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
6,18653250,,Removal of urethra gland,A,,6.36,3.82,NA,3.82,,0.82,11.00,11.00,0,090,0.08,0.83,0.09,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18753260,,Treatment of urethra lesion,A,,2.95,3.02,,1.58,,0.43,6.40,4.96,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18853265,,Treatment of urethra lesion,A,,3.09,3.38,,1.55,,0.46,6.93,5.10,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,18953270,,Removal of urethra gland,A,,3.06,3.10,,1.61,,0.40,6.56,5.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19053275,,Repair of urethra defect,A,,4.46,2.06,NA,2.06,,0.62,7.14,7.14,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,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.,,,,,,