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.

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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.

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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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