Stone Management - Boston Scientific
Stone Management
2024 Coding & Payment Quick Reference
This procedural reimbursement guide, for select Stone Management procedures, provides coding and reimbursement information for physicians and facilities. The Medicare payment amounts shown are national average payments. Actual reimbursement will vary for each provider and institution based on geographic differences in costs, hospital teaching status, and proportion of low-income patients.
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements. The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. We recommend consulting your relevant manuals for appropriate coding options.
The following codes are thought to be relevant to Stone Management procedures and are referenced throughout this guide.
CPT? / HCPCS Code
Code Description
Ureteroscopic Stone Management and Stent Insertion
52005
Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service
52310 52332 52352
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
52353 52356
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
CPT Copyright 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
See important notes on the uses and limitations of this information on page 9.
1
Stone Management
2024 Coding & Payment Quick Reference
CPT Codes (cont'd)
CPT /
HCPCS Code
Code Description
PCNL
50080 50081 50430
Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple
Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; complex
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access
50431
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access
50432
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
50433
Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, new access
50434
Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, via pre-existing nephrostomy tract
50435
Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation
50436
Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed
50437
Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; including new access into the renal collecting system
50561
Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus
50605
Ureterotomy for insertion of indwelling stent, all types
50693
Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; pre-existing nephrostomy tract
50694
Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter
50695
Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter (e.g., ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, with separate nephrostomy catheter
74420
Urography, retrograde, with or without KUB
Bladder Stones
52317
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm)
52318
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)
Select Bladder Tumor Procedures
52204
Cystourethroscopy, with biopsy(s)
52214
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
52224
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy
52234
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)
52235
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
52240
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s)
See important notes on the uses and limitations of this information on page 10.
2
Stone Management
2024 Coding & Payment Quick Reference
Physician Payment ? Medicare
All rates shown are 2024 Medicare national averages; actual rates will vary geographically and/or by individual facility. "Allowed Amount" is the amount Medicare determines to be the maximum allowance for any Medicare covered procedure. Actual payment will vary based on the maximum allowance less any applicable deductibles, co-insurances, etc.
CPT / HCPCS Code
Short Description
MD In-Office
MD In-Facility
Total Office-
Medicare Allowed Medicare Allowed Based
Amount
Amount
RVUs
Total Facility-
Based RVUs
Ureteroscopic Stone Management and Stent Insertion
52005
Cystourethroscopy, with ureteral catheterization
52310
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple
52332
Cystourethroscopy, with insertion of indwelling ureteral stent
52352
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus
$298 $314
$393 N/A
$129 $147
$151 $342
9.10 9.58
11.99 N/A
3.95 4.48
4.60 10.43
52353 52356
PCNL
50080 50081 50430
50431
50432
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent
PCNL or pyelostolithotomy; simple; up to 2 cm PCNL or pyelostolithotomy; complex; over 2 cm Injection procedure for antegrade nephrostogram and/or ureterogram; new access Injection procedure for antegrade nephrostogram and/or ureterogram; existing access Placement of nephrostomy catheter, percutaneous
N/A N/A
N/A N/A $613 $312 $875
$378 $401
$681 $1,095 $147 $64 $195
N/A N/A
N/A N/A 18.73 9.53 26.73
11.54 12.24
20.79 33.44 4.50 1.95 5.96
50433 50434 50435 50436 50437 50561 50605
Placement of nephroureteral catheter, percutaneous, new access Convert nephrostomy catheter Exchange nephrostomy catheter Dilation of existing tract endourologic percutaneous Dilation existing tract, new access renal collecting system Kidney endoscopy & treatment Insert ureteral support
$1,090 $875 $576 N/A N/A $467 N/A
$242 $182 $96 $143 $237 $381 $990
33.28 26.72 17.60 N/A N/A 14.27 N/A
7.40 5.56 2.92 4.38 7.25 11.63 30.22
50693
Placement ureteral stent percutaneous
50694
Placement ureteral stent percutaneous
50695
Placement ureteral stent percutaneous
74420
Urography, retrograde, with or without KUB
Bladder Stones
52317
Litholapaxy; simple or small (2.5 cm)
Select Bladder Tumor Procedures
$958 $1,075 $1,291 $77
$865 N/A
$194 $253 $325 N/A
$334 $456
29.27 32.82 39.42 2.34
26.43 N/A
5.93 7.74 9.93 N/A
10.20 13.94
52204
Cystourethroscopy, with biopsy(s)
$370
52214
Cystourethroscopy, with fulguration
$731
52224
Cystourethroscopy, with fulguration or treatment of minor ( ................
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