Crystal's MCW Coder Hub2026 Coding and Payment Guide - Cystoscopy-Based Procedures
The coding options listed within this guide are commonly used codes and are not intended to be an all-inclusive list. They are thought to be relevant to Cystoscopy-based procedures and are referenced throughout this document. We recommend consulting your relevant manuals for appropriate coding options. Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.
All rates shown throughout this guide are 2026 Medicare unadjusted national average; 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-insurance, etc.
To determine whether there are relevant C-codes for any Boston Scientific products, please visit our C-code finder at http://www.bostonscientific.com/en-US/reimbursement/ccode-finder.html. (See additional information on page 5).
CPT® codes with their respective long descriptions will be found on page 5.
Physician Payment - Medicare Unadjusted National Average
| CPT® Code | Code Description | MD In-Facility Medicare Allowed Amount | Total Facility Based RVUs | MD In-Office Medicare Allowed Amount | Total Office Based RVUs |
|---|---|---|---|---|---|
| Cystoscopy-based Procedures | |||||
| 52000 | Cystourethroscopy (separate procedure) | $71 | 2.13 | $216 | 6.46 |
| 52001 | Cystourethroscopy, with irrigation and evacuation of multiple obstructing clots | $253 | 7.57 | $420 | 12.56 |
| 52005 | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service | $120 | 3.58 | $281 | 8.40 |
| 52007 | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis | $148 | 4.43 | $432 | 12.93 |
| 52010 | Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service | $147 | 4.41 | $365 | 10.93 |
| 52204 | Cystourethroscopy, with biopsy(s) | $127 | 3.80 | $355 | 10.64 |
| 52214 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands | $152 | 4.55 | $728 | 21.80 |
| 52224 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy | $176 | 5.26 | $761 | 22.77 |
| 52234 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of SMALL bladder tumor(s) | $217 | 6.49 | N/A | N/A |
| 52235 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s) | $255 | 7.62 | N/A | N/A |
| 52240 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of LARGE bladder tumor(s) | $344 | 10.30 | N/A | N/A |
| 52250 | Cystourethroscopy, with insertion of radioactive substance, with or without biopsy or fulguration | $212 | 6.34 | N/A | N/A |
| 52260 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia | $186 | 5.56 | N/A | N/A |
| CPT® Code | Code Description | MD In-Facility Medicare Allowed Amount | Total Facility Based RVUs | MD In-Office Medicare Allowed Amount | Total Office Based RVUs |
|---|---|---|---|---|---|
| Cystoscopy-based Procedures | |||||
| 52265 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia | $144 | 4.32 | $346 | 10.35 |
| 52270 | Cystourethroscopy, with internal urethrotomy; female | $162 | 4.85 | $400 | 11.97 |
| 52275 | Cystourethroscopy, with internal urethrotomy; male | $219 | 6.56 | $519 | 15.54 |
| 52276 | Cystourethroscopy, with direct vision internal urethrotomy | $233 | 6.99 | N/A | N/A |
| 52277 | Cystourethroscopy, with resection of external sphincter (sphincterotomy) | $285 | 8.53 | N/A | N/A |
| 52281 | Cystourethroscopy, with calibration and/or dilation of urethral stricture or tenosis, with or without meatotomy, with or without injection procedure for cystography, male or female | $137 | 4.09 | $311 | 9.3 |
| 52282 | Cystourethroscopy, with insertion of permanent urethral stent | $297 | 8.89 | N/A | N/A |
| 52283 | Cystourethroscopy, with steroid injection into stricture | $179 | 5.35 | $332 | 9.95 |
| 52285 | Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or trigone | $173 | 5.19 | $326 | 9.76 |
| 52287 | Cystourethroscopy, with injection(s) for chemodenervation of the bladder (NOTE: See relevant HCPCS code on page 5). | $149 | 4.46 | $364 | 10.89 |
| 52290 | Cystourethroscopy, with ureteral meatotomy, unilateral or bilateral | $215 | 6.45 | N/A | N/A |
| 52300 | Cystourethroscopy, with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral | $247 | 7.4 | N/A | N/A |
| 52301 | Cystourethroscopy, with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral | $255 | 7.64 | N/A | N/A |
| 52305 | Cystourethroscopy, with incision or resection of orifice of bladder diverticulum, single or multiple | $245 | 7.33 | N/A | N/A |
| [[52310]] | With removal of foreign body, calculus, ureteral stent from urethra or bladder (separate procedure); simple | $135 | 4.03 | $299 | 8.94 |
| 52315 | Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated | $242 | 7.26 | $458 | 13.71 |
| 52317 | Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm) | $304 | 9.11 | $869 | 26.02 |
| 52318 | Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm) | $414 | 12.4 | N/A | N/A |
| 52320 | Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus | $216 | 6.48 | N/A | N/A |
| 52325 | Cystourethroscopy, (Including ureteral catheterization); with fragmentation of ureteral calculus (e.g., ultrasonic or electrohydraulic technique) | $282 | 8.43 | N/A | N/A |
| 52327 | Cystourethroscopy (Including ureteral catheterization); with subureteric injection of implant material | $225 | 6.74 | N/A | N/A |
| 52330 | Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus | $231 | 6.92 | $591 | 17.68 |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) | $140 | 4.18 | $373 | 11.16 |
| 52334 | Cystourethroscopy, with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde | $163 | 4.89 | N/A | N/A |
| CPT® Code | Code Description | APC | Hospital Outpatient Status Indicator | Hospital Outpatient Medicare Allowed Amount | ASC Medicare Allowed Amount |
|---|---|---|---|---|---|
| Cystoscopy-based Procedures | |||||
| [[52000]] | Cystourethroscopy (separate procedure) | 5372 | J1 | $712 | $311 |
| 52001 | Cystourethroscopy, with irrigation and evacuation of multiple obstructing clots | 5374 | J1 | $3,601 | $1,723 |
| [[52005]] | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service | 5373 | J1 | $2,136 | $1,002 |
| 52007 | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis | 5374 | J1 | $3,601 | $1,723 |
| 52010 | Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service | 5372 | J1 | $712 | $311 |
| [[52204]] | Cystourethroscopy, with biopsy(s) | 5373 | J1 | $2,136 | $1,002 |
| 52214 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands | 5374 | J1 | $3,601 | $1,723 |
| 52224 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy | 5374 | J1 | $3,601 | $1,723 |
| 52234 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of SMALL bladder tumor(s) | 5374 | J1 | $3,601 | $1,723 |
| 52235 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of MEDIUM bladder tumor(s) | 5374 | J1 | $3,601 | $1,723 |
| 52240 | Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of LARGE bladder tumor(s) | 5375 | J1 | $5,478 | $2,730 |
| 52250 | Cystourethroscopy, with insertion of radioactive substance, with or without biopsy or fulguration | 5374 | J1 | $3,601 | $1,723 |
| 52260 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia | 5373 | J1 | $2,136 | $1,002 |
| 52265 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia | 5373 | J1 | $2,136 | $237 |
| 52270 | Cystourethroscopy, with internal urethrotomy; female | 5373 | J1 | $2,136 | $1,002 |
| 52275 | Cystourethroscopy, with internal urethrotomy; male | 5373 | J1 | $2,136 | $1,002 |
| 52276 | Cystourethroscopy, with direct vision internal urethrotomy | 5373 | J1 | $2,136 | $1,002 |
| 52277 | Cystourethroscopy, with resection of external sphincter (sphincterotomy) | 5374 | J1 | $3,601 | $1,723 |
| 52281 | Cystourethroscopy, with calibration and/or dilation of urethral stricture or tenosis, with or without meatotomy, with or without injection procedure for cystography, male or female | 5373 | J1 | $2,136 | $1,002 |
| 52282 | Cystourethroscopy, with insertion of permanent urethral stent | 5374 | J1 | $3,601 | $1,723 |
| 52283 | Cystourethroscopy, with steroid injection into stricture | 5373 | J1 | $2,136 | $1,002 |
| 52285 | Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or trigone | 5372 | J1 | $712 | $311 |
| 52287 | Cystourethroscopy, with injection(s) for chemodenervation of the bladder (NOTE: See relevant HCPCS code on page 5). | 5373 | J1 | $2,136 | $1,002 |
| 52290 | Cystourethroscopy, with ureteral meatotomy, unilateral or bilateral | 5373 | J1 | $2,136 | $1,002 |
| CPT® Code | Code Description | APC | Hospital Outpatient Status Indicator | Hospital Outpatient Medicare Allowed Amount | ASC Medicare Allowed Amount |
|---|---|---|---|---|---|
| Cystoscopy-based Procedures | |||||
| 52300 | Cystourethroscopy, with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral | 5374 | J1 | $3,601 | $1,723 |
| 52301 | Cystourethroscopy, with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral | 5374 | J1 | $3,601 | $1,723 |
| 52305 | Cystourethroscopy, with incision or resection of orifice of bladder diverticulum, single or multiple | 5375 | J1 | $5,478 | $2,730 |
| 52310 | With removal of foreign body, calculus, ureteral stent from urethra or bladder (separate procedure); simple | 5373 | J1 | $2,136 | $1,002 |
| 52315 | Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated | 5373 | J1 | $2,136 | $1,002 |
| 52317 | Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm) | 5374 | J1 | $3,601 | $1,723 |
| 52318 | Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm) | 5374 | J1 | $3,601 | $1,723 |
| 52320 | Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus | 5374 | J1 | $3,601 | $1,723 |
| 52325 | Cystourethroscopy, (Including ureteral catheterization); with fragmentation of ureteral calculus (e.g., ultrasonic or electrohydraulic technique) | 5375 | J1 | $5,478 | $2,730 |
| 52327 | Cystourethroscopy (Including ureteral catheterization); with subureteric injection of implant material | 5375 | J1 | $5,478 | $3,847 |
| 52330 | Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus | 5374 | J1 | $3,601 | $1,723 |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) | 5374 | J1 | $3,601 | $1,723 |
| 52334 | Cystourethroscopy, with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde | 5374 | J1 | $3,601 | $1,723 |
“N/A” indicates that Medicare has not deemed this procedure to be reimbursable in this setting.
Hospital Inpatient Payment - Medicare Unadjusted National Average
MS-DRG assignment is based on a combination of diagnoses and procedure codes reported. While MS-DRGs listed in this guide represent likely assignments, Boston Scientific cannot guarantee assignment to any one specific MS-DRG.
| MS-DRG | Description | Reimbursement |
|---|---|---|
| 656 | Kidney and ureter procedures for neoplasm with MCC | $23,168 |
| 657 | Kidney and ureter procedures for neoplasm with CC | $13,316 |
| 658 | Kidney and ureter procedures for neoplasm without CC/MCC | $11,292 |
| 659 | Kidney and ureter procedures for non-neoplasm with MCC | $18,490 |
| 660 | Kidney and ureter procedures for non-neoplasm with CC | $9,618 |
| 661 | Kidney and ureter procedures for non-neoplasm without CC/MCC | $7,534 |
| 668 | Transurethral procedures with MCC | $21,248 |
| 669 | Transurethral procedures with CC | $11,294 |
| 670 | Transurethral procedures without CC/MCC | $7,112 |
The patient’s medical record must support the existence and treatment of the complication or co-morbidity
C-Code Information
For all C-Code information, please reference the C-code Finder: http://www.bostonscientific.com/en-US/reimbursement/ccode-finder.html.
| Code | OPPS Status Indicator | Description |
|---|---|---|
| C1889 | N (packaged)* | Implantable/insertable device, not otherwise classified |
*Source: https://www.cms.gov/license/ama?file=/files/zip/2026-nfrm-opps-addenda.zip
On claims for Medicare beneficiaries, hospitals should report not only the appropriate CPT® Code, but also all applicable C-Codes.
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C-Codes are tracking codes established by the Centers for Medicare & Medicaid Services (CMS) to assist Medicare in establishing future APC payment rates. C-Codes only apply to Medicare hospital outpatient and Ambulatory Surgery Center (ASC) claims. They do not trigger additional payment to the facility with the exception of designated transitional pass-through payment (TPT) devices.
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It’s important that hospitals report C-Codes as well as the associated device costs as this may help inform more accurate future outpatient hospital payment rates.
Suggested Revenue Code for Device Codes C1889
| Code | Description |
|---|---|
| 0278† | Medical/surgical supplies and devices/other implants |
CPT® Codes with Long Descriptions
| CPT® Code | Long Description |
|---|---|
| 52000 | Cystourethroscopy (separate procedure) |
| 52001 | Cystourethroscopy, with irrigation and evacuation of multiple obstructing clots |
| 52005 | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; |
| 52007 | Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis |
| 52010 | Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service |
| 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) |
| 52250 | Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration |
| 52260 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia |
| 52265 | Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia |
| 52270 | Cystourethroscopy, with internal urethrotomy; female |
| 52275 | Cystourethroscopy, with internal urethrotomy; male |
| 52276 | Cystourethroscopy with direct vision internal urethrotomy |
| 52277 | Cystourethroscopy, with resection of external sphincter (sphincterotomy) |
| 52281 | Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female |
| 52282 | Cystourethroscopy, with insertion of permanent urethral stent |
| 52283 | Cystourethroscopy, with steroid injection into stricture |
| CPT® Code | Long Description, continued |
|---|---|
| 52285 | Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or trigone |
| 52287 | Cystourethroscopy, with injection(s) for chemodenervation of the bladder |
| 52290 | Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral |
| 52300 | Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral |
| 52301 | Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral |
| 52305 | Cystourethroscopy; with incision or resection of orifice of bladder diverticulum, single or multiple |
| 52310 | Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple |
| 52315 | Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated |
| 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) |
| 52320 | Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus |
| 52325 | Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique) |
| 52327 | Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant material |
| 52330 | Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) |
| 52334 | Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous nephrostomy, retrograde |
Cystoscopy-Based Procedures
Physician payment rates are 2026 Medicare national averages. Source: Centers for Medicare and Medicaid Services. CMS-1832-F, Physician Fee Schedule - Addendum B, Relative Value File October 2025 release, RVU24D file. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
The 2026 National Average Medicare physician payment rates have been calculated using a 2026 conversion factor effective January 1, 2026, of $33.4009. Rates subject to change.
Hospital outpatient payment rates are 2026 Medicare OPPS Addendum B national averages. Source: Centers for Medicare and Medicaid Services. CMS OPPS - November 2025 release, CMS-1834-FC file. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc
ASC payment rates are 2026 Medicare ASC Addendum AA national averages. ASC rates are from the 2026 Ambulatory Surgical Center Covered Procedures List. Source: Centers for Medicare and Medicaid Services. CMS ASC November 2025 release, ASC Approved HCPCS Code and Payment Rates https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and-notices/cms-1834-fc
National average (wage index greater than one and hospital submitted quality data and is a meaningful EHR user) MS-DRG rates calculated using the national adjusted full update standardized labor, non-labor, and capital amounts. Source: August 4, 2025. Federal Register, CMS-1833-IFC. FY 2026 rates. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2026-ipps-final-rule-home-page
ICD-10 MS-DRG definitions from the CMS ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual. Source: https://www.cms.gov/icd10m/FY2025-NPRM-Version42-fullcode-cms/fullcode_cms/P0001.html
† According to Medicare, devices do not need to remain in the body to be classified as “implants.”1,2
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Preamble to the Inpatient Prospective Payment update regulation for FY 2009 (73 FR 48462).
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Revenue Code 278 - Definition in UB-04 manual, National Uniform Billing Committee Summary, August 2009, Page 5: (a) Implantables: That which is implanted, such as a piece of tissue, a tooth, a pellet of medicine, or a tube or needle containing a radioactive substance, a graft, or an insert. Also included are liquid and solid plastic materials used to augment tissues or to fill in areas traumatically or surgically removed. An object or material partially or totally inserted or grafted into the body for prosthetic, therapeutic, diagnostic purposes. Examples of Other Implants (not all-inclusive): Stents, artificial joints, shunts, grafts, pins, plates, screws, anchors, radioactive seeds.
Please note: this coding information may include codes for procedures for which Boston Scientific currently offers no cleared or approved products. In those instances, such codes have been included solely in the interest of providing users with comprehensive coding information and are not intended to promote the use of any Boston Scientific products for which they are not cleared or approved. The Health Care Provider (HCP) is solely responsible for selecting the site of service and treatment modalities appropriate for the patient based on medically appropriate needs of that patient and the independent medical judgement of the HCP.
Health economic and reimbursement information provided by Boston Scientific Corporation is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice. Boston Scientific encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently. Boston Scientific recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters. Boston Scientific does not promote the use of its products outside their FDA-approved or FDA-cleared label. Information included herein is current as of November 2025 but is subject to change without notice. Rates for services are effective January 1, 2026.
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.
Sequestration Disclaimer Rates referenced in these guides do not reflect Sequestration or other reductions that may be implemented in 2026.
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