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51595

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👩🏾‍⚕️ CPT Code 51595: Documentation & Billing Guide

Catheterization, Ureteral, Therapeutic (Injections/Infusions), Including Imaging Guidance (Fluoroscopy or Ultrasound)

Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant
Specialty Tags: urology CPT urology

QUICK REFERENCE

ElementDetails
Code51595
Code TypeTherapeutic Procedure - Urology/Interventional Radiology
Procedure TypeUreteral catheterization with therapeutic injection/infusion and imaging guidance
Global Period010 days (minor surgical procedure)
Work RVU (2025)1.91 RVU
Practice Expense RVU (2025, Non-Facility)1.47 RVU
Practice Expense RVU (2025, Facility)0.75 RVU
Malpractice RVU (2025)0.16 RVU
Total RVU (2025, Non-Facility)3.54 RVU
Total RVU (2025, Facility)2.82 RVU
2025 Medicare Fee (Non-Facility)~32.3465 CF × GPCI)
2025 Medicare Fee (Facility)~32.3465 CF × GPCI)
Conversion Factor (2025)$32.3465
Estimated Commercial Insurance800
Global Period IncludesPre-operative visit (day before), procedure, post-operative visits (10 days)
Common Place of ServiceHospital outpatient (22), ASC (24), office procedure room with fluoroscopy (11)
SpecialtyUrology, Interventional Radiology, Nephrology
Procedure Time15-45 minutes

📋SHORT DEFINITION

CPT 51595 describes therapeutic catheterization of the ureter with therapeutic injection or infusion of medication, performed with imaging guidance (fluoroscopy or ultrasound). This procedure involves percutaneous or endoscopic placement of a catheter into the ureteral lumen for delivery of therapeutic agents (mitomycin C for recurrent ureteropelvic junctions, antifungal agents, chemotherapy, urokinase for clots, etc.).

LONG DEFINITION

CPT 51595 represents a therapeutic ureteral intervention combining catheter placement with direct injection or infusion of medications into the ureteral lumen. Imaging guidance is required to ensure proper catheter placement and medication delivery.

Clinical Indications for 51595

Recurrent Ureteropelvic Strictures:

  • Mitomycin C injection to reduce stricture recurrence and promote healing
  • Post-operative stricture management
  • Prevention of re-stenosis after endoscopic treatment

Ureteral Obstruction/stenosis Management:

  • Antifungal infusion (amphotericin B) for fungal infections
  • Urokinase infusion for thromboembolic obstruction
  • Contrast infusion for diagnostic imaging

Urothelial Preservation Therapy:

  • Mitomycin C or bacillus Calmette-Guérin (BCG) instillation for upper tract urothelial cancer
  • Topical chemotherapy for recurrent upper tract transitional cell carcinoma

Infection Management:

  • Antifungal therapy for candida uretritis/pyelonephritis
  • Antibiotic infusions for resistant infections
  • Antimicrobial prophylaxis

Other Indications:

  • Dye studies for diagnostic assessment
  • Medication delivery for pain management
  • Investigational therapies

Procedure Technique

Percutaneous Approach (Most Common):

  • Patient positioned prone or lateral decubitus
  • Ultrasound or fluoroscopic guidance for needle placement
  • Percutaneous access to dilated collecting system or proximal ureter
  • 0.038” guidewire advanced into ureter
  • 5-7 French catheter advanced over guidewire
  • Catheter tip positioned in desired ureteral location
  • Therapeutic agent injected or infused through catheter
  • Catheter removed
  • Access tract managed (usually percutaneous, no sutures needed)

Endoscopic Approach (Alternative):

  • cystoscopy performed
  • Ureteral orifice cannulated under direct visualization
  • 4-6 French catheter advanced into ureter
  • Therapeutic agent delivered
  • Catheter removed

Imaging Guidance Requirements:

  • Fluoroscopy: Real-time imaging to guide catheter placement and confirm position
  • Ultrasound: Used to guide needle placement for percutaneous access
  • Both: Often performed in combination

Procedure Duration: Typically 15-45 minutes

Key Distinctions:

  • CPT 51595 = Therapeutic ureteral catheterization with injection/infusion (requires specific intervention)
  • CPT 50693 = Percutaneous ureteral stent placement (different intervention, stent placement)
  • CPT 50390 = Aspiration of renal cyst (diagnostic, not therapeutic injection)
  • CPT 52005 = cystourethroscopy with ureteral catheterization (endoscopic approach)

Important Note:

CPT 51595 includes imaging guidance (fluoroscopy or ultrasound) as part of the code. Separate imaging codes are NOT billed.

WORK RELATIVE VALUE UNITS (wRVUs) & COMPONENTS

Work RVU Breakdown (2025)

RVU ComponentValueWhat It Represents
Work RVU1.91Physician work, technical skill, decision-making
Practice Expense RVU (non-facility)1.47Catheterization equipment, imaging, medications (mitomycin C, etc.)
Practice Expense RVU (facility)0.75Lower due to hospital/ASC equipment overhead
Malpractice RVU0.16Malpractice insurance and liability (minor therapeutic procedure)
TOTAL RVU (non-facility)3.54Total relative value units
TOTAL RVU (facility)2.82Total relative value units (lower)

RVU Conversion to Dollar Amount (2025)

Formula: RVU × Conversion Factor (CF) × Geographic Practice Cost Index (GPCI) = Payment

2025 Medicare Conversion Factor: $32.3465

Typical Calculations (Non-Facility, GPCI = 1.0):

  • 1.91 wRVU × 61.78** (work component)
  • 1.47 PE RVU × 47.57** (practice expense)
  • 0.16 MP RVU × 5.18** (malpractice)
  • Total = ~$114.55 per procedure (non-facility, GPCI 1.0)

Facility-Based (Hospital/ASC):

  • 1.91 wRVU × 61.78** (work component, same)
  • 0.75 PE RVU × 24.26** (practice expense, lower)
  • 0.16 MP RVU × 5.18** (malpractice, same)
  • Total = ~$91.25 per procedure (facility, GPCI 1.0)

Real-World Range (2025):

  • Non-Facility: 135 (depending on GPCI)
  • Facility-Based: 105

GLOBAL PERIOD

Global Period Status: 010 days (10-Day Global)

What This Means:

  • CPT 51595 has a 10-day global period
  • Includes: Pre-operative visit (day before), procedure, post-operative visits within 10 days (routine follow-up)
  • One flat fee covers all bundled services
  • No additional E/M billing for routine post-operative complications during 10 days
  • Separate payment only for unrelated issues (use modifier -24)

Billing Implications:

  • Cannot bill separate office visit codes within 10 days for related care
  • CAN bill separate codes for unrelated problems with modifier -24
  • Follow-up imaging (e.g., follow-up CT scan to assess stricture resolution) at 4+ weeks post-op may be separately billable (timing dependent)

DOCUMENTATION REQUIREMENTS FOR 51595

Minimum Documentation Components

Pre-Operative Assessment:

Indication/History:

  • Chief complaint: Ureteral stricture, obstruction, fungal infection, cancer, etc.
  • Duration and severity of problem
  • Prior interventions and outcomes
  • Symptoms (flank pain, obstruction, recurrent pyelonephritis, hematuria, etc.)
  • Medical history relevant to procedure
  • Imaging findings (CT scan, ultrasound showing dilation, stricture location, etc.)

Physical Examination:

  • Flank assessment (tenderness, masses, scars from prior procedures)
  • Abdominal exam (distention, masses, scars)
  • Vital signs
  • Allergies and comorbidities affecting procedure choice

Imaging Review:

  • Pre-operative imaging studied: CT scan, ultrasound, prior imaging showing stricture location, dilation, etc.
  • Specific measurements documented (stricture length mm, degree of dilation, hydronephrosis grade)
  • Collecting system dilation confirmed

Informed Consent:

  • Risks documented: Perforation, bleeding, infection, medication reaction, failure to resolve obstruction
  • Benefits: Stricture resolution, pain relief, prevention of renal loss
  • Alternatives: Conservative management, percutaneous nephrostomy, stent placement, repeat surgical correction

Procedure Documentation:

Access and Catheterization:

  • Approach: Percutaneous (if so, which access: lumbar, lateral, medial) vs. endoscopic
  • Imaging used: Fluoroscopy, ultrasound, or both
  • Needle placement: Under [fluoroscopic / ultrasound] guidance to [collecting system / proximal ureter]
  • Guidewire: 0.038” guidewire advanced into ureter; position confirmed with imaging
  • Catheter: 5-7 French catheter advanced over guidewire into ureter
  • Catheter tip location: Specific position documented (proximal ureter, ureteropelvic junction, etc.)
  • Position confirmation: Imaging confirms appropriate catheter positioning before injection/infusion

Therapeutic Agent Injection/Infusion:

  • Medication: Type, concentration, volume delivered
    • Example: Mitomycin C 0.4 mg/mL, 4mL delivered (1.6 mg total)
  • Infusion technique: Slow injection vs. drip infusion; time of infusion
  • Dwell time: If applicable (e.g., mitomycin C dwell time of 30 minutes)
  • Flow characteristics: Noting any backflow, extravasation, or complications during injection

Imaging During Procedure:

  • Fluoroscopic images obtained confirming catheter position before injection
  • Contrast injected to verify proper location and drainage
  • Images confirming medication delivery

Post-Catheterization:

  • Catheter removal method and ease of removal
  • Confirmation of urine drainage post-removal
  • Assessment of collection system post-procedure
  • Drainage: Is drainage spontaneous, patent, or compromised?

Complications:

  • None vs. specific issues (bleeding, perforation, extravasation of medication, malposition, inability to access, etc.)

Post-Operative Instructions:

  • Activity restrictions
  • Hydration recommendations
  • Antibiotic prophylaxis (if indicated)
  • Pain management
  • When to report complications (fever, uncontrolled pain, hematuria, etc.)
  • Follow-up imaging schedule (usually 4-6 weeks post-op to assess stricture response)

BILLING RULES & MODIFIERS

Global Period Coverage

What’s Included in 51595: ✓ Pre-operative evaluation ✓ The procedure including catheterization, injection, and imaging guidance ✓ Post-operative visits within 10 days ✓ Routine post-operative complication management

✗ NOT Included (Can bill separately):

  • Unrelated E/M during 10-day period (use modifier -24)
  • Follow-up imaging >10 days post-op (typically separately billable)
  • Separately identifiable E/M service same day (use modifier -25 for E/M)

Common Modifiers

ModifierDescriptionWhen to Use
-24Unrelated E/M during postoperative periodWhen billing E/M for unrelated problem during 10 days
-25Significant, separately identifiable E/MWhen billing E/M same day for separate service
-50Bilateral procedureIf bilateral ureteral catheterization performed (rare)
-RT/-LTRight/LeftIf unilateral procedure (apply to 51595)
None (most common)Standard billingRoutine unilateral procedure

MEDICARE RULES FOR 51595

CMS-Specific Rules & Policies

1. Global Period Management

  • 10-day global period for all routine post-operative care
  • All routine post-op visits bundled
  • Unrelated services must use modifier -24

2. Facility vs. Non-Facility Billing

  • Non-Facility: Higher PE RVU (1.47), higher reimbursement (~$114.55)
  • Facility: Lower PE RVU (0.75), lower reimbursement (~$91.25)
  • Facility bills separately for facility charges

3. Imaging Guidance Included

  • CPT 51595 includes imaging guidance (fluoroscopy or ultrasound)
  • Do NOT bill separate fluoroscopy codes (separately owned fluoroscopy equipment may have different reimbursement)
  • Verify your facility’s imaging billing policy (owned vs. leased equipment)

4. Medication Costs

  • Medications (mitomycin C, antifungal agents, etc.) typically NOT included in procedure code
  • Hospital or ASC bills separately for medication as hospital supply charge
  • Verify your facility’s medication billing practices

5. Bilateral Procedures

  • If bilateral ureteral catheterization performed same day, use modifier -50
  • Or bill each side separately with -RT and -LT
  • Most insurers pay both sides; some may reduce second side payment

LOCAL COVERAGE DETERMINATIONS (LCDs) & NATIONAL COVERAGE

National Coverage Determination (NCD)

There is NO specific NCD for CPT 51595.

General Medicare Coverage Policy:

  • Ureteral procedures covered when medically necessary to manage ureteral obstruction, strictures, or infections
  • Therapeutic interventions (stricture treatment, infection management) covered when conservative measures inadequate
  • Pre-authorization may be required by some MACs

Local Coverage Determinations (LCDs) - MAC-Specific

LCDs vary by Medicare Administrative Contractor (MAC) jurisdiction.

Common LCD Requirements:

RequirementDetails
Medical NecessityObstructive uropathy, recurrent stricture, or infection management
DocumentationImaging confirming obstruction/stricture, prior conservative treatment
Diagnosis CodeICD-10 showing obstruction, stricture, or infection
Conservative TreatmentMay require documentation that conservative measures (antibiotics, hydration) have failed

To Find Your MAC’s LCD:

  1. Go to CMS LCD Search Tool: https://www.cms.gov/cclc/lcd
  2. Enter your MAC jurisdiction
  3. Search for “ureteral catheterization,” “mitomycin,” or “stricture management”
  4. Review specific coverage criteria

2025 REIMBURSEMENT INFORMATION

Medicare 2025 Fee Schedule

CPT 51595 - Therapeutic Ureteral Catheterization with Injection/Infusion

CategoryValue
Work RVU1.91
Practice Expense RVU (non-facility)1.47
Practice Expense RVU (facility)0.75
Malpractice RVU0.16
Total RVU (non-facility)3.54
Total RVU (facility)2.82
Conversion Factor (2025)$32.3465
National Average Fee (Non-Facility, GPCI 1.0)$114.55
Estimated Range (Non-Facility)$105 - 135
National Average Fee (Facility, GPCI 1.0)$91.25
Estimated Range (Facility)$85 - 105

Commercial Insurance & Medicaid Reimbursement (2025)

Commercial Insurance:

  • Typically pays 2-3× Medicare rates
  • Estimated 51595 payment: 800 (varies by payer)
  • Usually covers with appropriate clinical indication and medical necessity

Medicaid:

  • Varies significantly by state
  • Estimated 51595 payment: 200 (state-dependent)
  • Coverage varies; some states cover therapeutic ureteral procedures, others limit coverage

Self-Pay/Cash Price:

  • Typically 600

Ureteral Intervention Codes

CodeDescriptionRVU (Work)Global
51595Therapeutic ureteral catheterization with injection/infusion (with imaging)1.91010
50693percutaneous ureteral stent placement2.41010
50690Percutaneous ureteral stent removal and replacement2.15010
50395Percutaneous placement of ureteral stent, imaging-guided3.30010
52005cystourethroscopy with ureteral catheterization (endoscopic)1.40010

FREQUENTLY BILLED SCENARIOS FOR 51595

Scenario 1: Mitomycin C Injection for Recurrent Ureteropelvic Stricture

Patient: 52-year-old with history of pyeloplasty 3 years prior, now with recurrent UPJ stricture Clinical Assessment:

Procedure:

  • Percutaneous access to collecting system under ultrasound/fluoroscopic guidance
  • 6 French catheter advanced to UPJ
  • 0.4 mg/mL mitomycin C injected (total 1.6mg in 4mL)
  • 30-minute dwell time maintained
  • Catheter flushed with normal saline and removed
  • Spontaneous drainage confirmed post-removal

Coding:

  • 51595 (therapeutic ureteral catheterization with mitomycin C injection)
  • Diagnosis: N13.30 (hydronephrosis with ureteric obstruction, right), Z87.448 (personal history of urologic surgery)

Scenario 2: Antifungal Infusion for Candida Uretritis

Patient: 68-year-old immunocompromised patient with candida pyelonephritis unresponsive to systemic fluconazole

Clinical Assessment:

  • Urine culture: Candida albicans
  • Symptoms: Flank pain, dysuria despite oral fluconazole
  • Imaging: Mild hydronephrosis

Procedure:

  • Endoscopic approach via cystourethroscopy
  • Right ureteral orifice cannulated
  • 5 French catheter advanced into right ureter
  • Amphotericin B 0.5 mg/mL infused slowly (10 mL total = 5mg)
  • Catheter removed; spontaneous drainage verified

Coding:

Scenario 3: Bilateral Therapeutic Ureteral Catheterization

Patient: 45-year-old with recurrent fungal upper tract infections, bilateral ureteral involvement

Procedure:

  • Percutaneous access bilaterally
  • Bilateral catheters placed
  • Antifungal therapy delivered to both ureters

Coding:

  • 51595-50 (bilateral therapeutic ureteral catheterization)
  • OR bill separately: 51595-RT (right) + 51595-LT (left)

DOCUMENTATION TIPS FOR 51595

What to Document

✓ SHOULD INCLUDE:

  1. Indication for Procedure - Recurrent stricture, obstruction, fungal infection, malignancy, etc.
  2. Imaging Findings - Specific measurements of stricture/dilation; degree of hydronephrosis; stricture location
  3. Prior Interventions - History of pyeloplasty, stent placement, endoscopic management, etc.
  4. Access Approach - Percutaneous vs. endoscopic; specific access site if percutaneous
  5. Imaging Guidance - Fluoroscopy and/or ultrasound used for access and verification
  6. Guidewire Advancement - 0.038” guidewire passed into ureter; position confirmed
  7. Catheter Placement - French size, type, position documented; imaging confirms position
  8. Therapeutic Agent - Type, concentration, volume delivered, dwell time if applicable
  9. Injection Technique - Slow injection, drip infusion, backflow observed, extravasation noted (or none)
  10. Drainage Assessment - Spontaneous drainage post-catheter removal; patent drainage confirmed
  11. Imaging Confirmation - Fluoroscopic images confirm catheter position and medication delivery
  12. Complications - None vs. specific issues (bleeding, perforation, malposition, etc.)
  13. Post-Operative Plan - Activity restrictions, hydration, antibiotics, follow-up imaging schedule
  14. Medications - Any perioperative antibiotics or prophylaxis given

✗ SHOULD AVOID:

  • Vague indication (“ureteral catheterization” without specifics)
  • Missing imaging findings (no measurements of stricture/dilation)
  • Incomplete access documentation (which approach? under what guidance?)
  • No mention of catheter position verification
  • Missing therapeutic agent details (no volume, concentration, dwell time)
  • No documentation of post-removal drainage assessment

Sample Operative Note Template

PROCEDURE NOTE - Therapeutic Ureteral Catheterization with Injection (51595)

PATIENT: [Name]
DATE: [Date]
PROVIDER: [Name, Credentials]
LOCATION: Hospital OR / ASC / Office procedure room

INDICATION:
[Age]-year-old patient with [indication: recurrent UPJ stricture / fungal infection / ureteral obstruction / cancer] presenting for [therapeutic intervention: mitomycin C application / antifungal infusion / chemotherapy].

IMAGING REVIEW: Pre-operative imaging: [CT/ultrasound findings]

  • Right/left hydronephrosis: [grade / degree of dilation]
  • Stricture location: [UPJ / mid-ureter / etc.]
  • Stricture dimensions: [length mm × width mm]
  • [Other relevant findings]

PRE-OPERATIVE ASSESSMENT:

  • Patient counseled on procedure, risks, benefits, alternatives
  • Informed consent obtained
  • NPO status confirmed if appropriate
  • Allergies documented: [None / specific allergies]
  • Relevant comorbidities: [noted]

PROCEDURE:

Access: Percutaneous renal access obtained under [fluoroscopic / ultrasound] guidance:

  • Patient positioned: [Prone / lateral decubitus]
  • 18-gauge needle placed percutaneously to [collecting system / proximal ureter] under [imaging] guidance
  • Needle positioned [specify: upper/middle/lower calyx or specific location]
  • 0.038” guidewire advanced into [collecting system / ureter] without resistance
  • Position confirmed with fluoroscopic imaging: [guidewire coils appropriately in ureter/bladder]
  • Antegrade contrast injection confirms [specify: patent collecting system, good drainage, stricture location, etc.]

Catheterization: 6 French open-ended ureteral catheter advanced over guidewire into ureter under fluoroscopic guidance:

  • Catheter tip positioned: [UPJ / proximal ureter / specific location]
  • Fluoroscopic imaging confirms proper catheter positioning: [Tip position documented with imaging]
  • Contrast injected through catheter confirming: [Good placement, no extravasation, stricture location confirmed]

Therapeutic Injection/Infusion:

  • Medication: Mitomycin C (or specify alternative medication)
  • Concentration: 0.4 mg/mL
  • Volume: 4 mL
  • Total Dose: 1.6 mg
  • Injection Technique: Slow injection over 1-2 minutes [or specify infusion method]
  • Dwell Time: 30 minutes with catheter in place
  • Observation: [No backflow / minimal backflow / other observations] during injection
  • No extravasation observed on fluoroscopic imaging

Post-Injection: After dwell time:

  • 10 mL normal saline flush through catheter
  • Antegrade imaging: [Contrast flows freely / stricture site assessed / other findings]
  • Catheter withdrawn
  • Post-withdrawal assessment: Spontaneous drainage from access tract confirmed [urine drips freely / etc.]
  • Final fluoroscopic imaging: [Collecting system appearance post-procedure, drainage pattern]

Disposition: Percutaneous access tract managed: [Guidewire removed, needle tract self-sealing / other management]

COMPLICATIONS: None

MEDICATIONS:

  • Perioperative antibiotic: [Specify type/dose if given]
  • Local anesthesia: [Type and volume]

POST-OPERATIVE INSTRUCTIONS:

  1. Activity: Limited activity × 3-5 days; return to normal as tolerated
  2. Hydration: Increase fluid intake to promote drainage
  3. Pain management: [Medication regimen]
  4. Antibiotic prophylaxis: [If indicated]
  5. Follow-up imaging: CT scan or ultrasound scheduled [date] to assess stricture response
  6. Return if: Fever >101°F, uncontrolled pain, gross hematuria, sepsis signs

ASSESSMENT: Successful percutaneous therapeutic ureteral catheterization with [mitomycin C injection / antifungal infusion / other therapy] for [indication]. Catheter removed with satisfactory drainage confirmed.

AUDIT DEFENSE CHECKLIST FOR 51595

Before billing 51595, verify:

  • Medical necessity documented - Obstruction, stricture, or infection clearly documented
  • Imaging findings documented - Specific measurements (stricture length mm, dilation grade, etc.)
  • Access approach documented - Percutaneous or endoscopic; specific site if percutaneous
  • Imaging guidance documented - fluoroscopy or ultrasound used to guide access and verify position
  • Catheter placement verified - Imaging confirms appropriate catheter position
  • Therapeutic agent documented - Type, concentration, volume delivered clearly stated
  • Dwell time documented - If applicable (e.g., mitomycin C dwell time)
  • Post-removal drainage assessment - Spontaneous drainage confirmed after catheter removal
  • Complications documented - Or note “none”
  • Post-operative plan documented - Follow-up imaging schedule, activity restrictions, signs to report
  • Diagnosis code supports indication - ICD-10 shows obstruction, stricture, or infection
  • Prior interventions documented - If this is repeat procedure, prior treatment documented

RED FLAGS FOR AUDITORS

51595 claims are at audit risk if:

  • ❌ Medical necessity not documented (no imaging findings, no obstruction confirmed)
  • ❌ Imaging findings missing or vague (no measurements of stricture/dilation)
  • ❌ Access approach not specified (percutaneous vs. endoscopic?)
  • ❌ Catheter position not verified (no imaging confirmation)
  • ❌ Therapeutic agent details incomplete (no volume, concentration, dwell time)
  • ❌ No documentation of post-removal drainage assessment
  • ❌ Documentation appears generic or copy-pasted
  • ❌ Diagnosis code unrelated to procedure
  • ❌ No imaging guidance documented (fluoroscopy or ultrasound?)

FREQUENTLY ASKED QUESTIONS (FAQs)

Q: Can I bill imaging separately if I perform fluoroscopy for 51595?
A: No. Imaging guidance (fluoroscopy or ultrasound) is included in CPT 51595. Do NOT bill separate fluoroscopy or ultrasound codes. Exception: Some facilities bill fluoroscopy equipment use separately; verify your payer’s policy.

Q: Is the medication cost (mitomycin C) included in 51595?
A: No. The procedure code covers only the catheterization and injection. Medication is typically billed separately as a hospital supply or pharmaceutical charge. Verify your facility’s medication billing practices.

Q: Can I bill 51595 for both a right and left ureter on the same day?
A: Yes. Use modifier -50 (bilateral) or bill each side separately with -RT (right) and -LT (left). Most insurers pay both sides.

Q: What’s the difference between 51595 and 52005?
A: 51595 is percutaneous or endoscopic access with therapeutic injection. 52005 is endoscopic access (cystoscopic) with ureteral catheterization. If cystoscopy performed with 52005, use that code instead.

Q: Can I bill 51595 + stent placement (50693) same day?
A: Verify payer policy. Some insurers cover both; others bundle them. Both procedures have 10-day global periods. Check with your payer before billing both codes.

Q: What’s included in the 10-day global period?
A: Pre-operative evaluation, the procedure, and post-operative visits/complication management within 10 days. No additional E/M billing for related care during 10 days.

REAL-WORLD BILLING TIPS

Tips to Maximize Compliance & Revenue

  1. Document imaging findings - Specific measurements (stricture length, dilation degree)
  2. Verify imaging billing - Clarify whether imaging is included or separately billable for your payer
  3. Clarify medication billing - Confirm medication cost billing (hospital charge vs. procedure code)
  4. Use appropriate modifiers - -50 for bilateral, -24 for unrelated post-op services
  5. Pre-authorization recommended - For stricture management or repeat procedures; submit prior imaging
  6. Document prior interventions - If repeat procedure, document prior treatment outcomes
  7. Include drainage assessment - Post-removal drainage confirmation important for audit defense
  8. Keep notes specific - Describe actual procedure; avoid generic copy-paste documentation
  9. Document contraindications to surgery - If this is non-surgical alternative to repeat pyeloplasty, document rationale
  10. Schedule follow-up imaging - Document when post-operative imaging planned to assess stricture response

BILLING & CODING RESOURCES

Recommended Resources:

SUMMARY TABLE

ElementDetails
Official DefinitionTherapeutic ureteral catheterization with injection/infusion, including imaging guidance
Global Period010 days (minor surgical procedure)
Work RVU (2025)1.91
Total RVU (2025, Non-Facility)3.54
Medicare Payment (2025, Non-Facility)~$115
Medicare Payment (2025, Facility)~$91
Typical Time15-45 minutes
Provider RequiredUrologist, interventional radiologist, qualified nephrologist
Common Modifiers-50 (bilateral), -24 (unrelated E/M), -25 (separate E/M)
Typical UseStricture treatment, infection management, cancer therapy
Common MistakesMissing imaging findings; no catheter position verification; incomplete medication documentation
Audit RiskModerate (medical necessity and imaging documentation critical)
BundlingIncludes imaging guidance; medication usually billed separately
Telehealth AllowedNo (requires in-person invasive procedure)

Document Created: February 2026
Compliant with: 2025 Medicare Physician Fee Schedule, CMS National and Local Coverage Determinations
Last Updated: February 2026

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