Crystal's MCW Coder Hub2026 Coding and Payment Guide - Stone Management 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 Stone Management 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 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-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.
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 |
|---|---|---|---|---|---|
| Ureteroscopic Stone Management and Stent Insertion | |||||
| 52005 | Cystourethroscopy, with ureteral catheterization | $120 | 3.58 | $281 | 8.40 |
| 52310 | Cystourethroscopy, with removal of foreign body, calculus, or 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 |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent | $140 | 4.18 | $373 | 11.16 |
| 52352 | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus | $312 | 9.33 | N/A | N/A |
| 52353 | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy | $344 | 10.30 | N/A | N/A |
| 52356 | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent | $365 | 10.93 | N/A | N/A |
| PCNL and Associated Procedures | |||||
| 50080 | PCNL or pyelostolithotomy; simple; up to 2 cm | $628 | 18.81 | N/A | N/A |
| 50081 | PCNL or pyelostolithotomy; complex; over 2 cm | $1,002 | 29.99 | N/A | N/A |
| 50430 | Injection procedure for antegrade nephrostogram and/or ureterogram; new access | $136 | 4.06 | $617 | 18.48 |
| 50431 | Injection procedure for antegrade nephrostogram and/or ureterogram; existing access | $59 | 1.77 | $308 | 9.23 |
| 50432 | Placement of nephrostomy catheter, percutaneous | $178 | 5.32 | $864 | 25.88 |
| 50433 | Placement of nephroureteral catheter, percutaneous, new access | $219 | 6.57 | $1,076 | 32.20 |
| 50434 | Convert nephrostomy catheter | $167 | 4.99 | $866 | 25.92 |
| 50435 | Exchange nephrostomy catheter | $88 | 2.63 | $564 | 16.88 |
| 50436 | Dilation of existing tract endourologic percutaneous | $136 | 4.08 | 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 |
|---|---|---|---|---|---|
| PCNL and Associated Procedures, Continued | |||||
| 50437 | Dilation existing tract, new access renal collecting system | $224 | 6.71 | N/A | N/A |
| 50561 | Kidney endoscopy & treatment | $346 | 10.37 | $495 | 14.82 |
| 50605 | Insert ureteral support | $936 | 28.02 | N/A | N/A |
| 50693 | Placement ureteral stent percutaneous | $176 | 5.28 | $947 | 28.35 |
| 50694 | Placement ureteral stent percutaneous | $229 | 6.86 | $1,061 | 31.78 |
| 50695 | Placement ureteral stent percutaneous | $293 | 8.78 | $1,274 | 38.13 |
| 74420 | Urography, retrograde, with or without KUB | N/A | N/A | $81 | 2.43 |
| Bladder Stones | |||||
| 52317 | Litholapaxy; simple or small (<2.5 cm) | $304 | 9.11 | $869 | 26.02 |
| 52318 | Litholapaxy; complicated or large (>2.5 cm) | $414 | 12.4 | N/A | N/A |
| Select Bladder Tumor Procedures | |||||
| 52204 | Cystourethroscopy, with biopsy(s) | $127 | 3.80 | $355 | 10.64 |
| 52214 | Cystourethroscopy, with fulguration | $152 | 4.55 | $728 | 21.8 |
| 52224 | Cystourethroscopy, with fulguration or treatment of minor (<0.5 cm) lesion(s) | $176 | 5.26 | $761 | 22.77 |
| 52234 | Cystourethroscopy, with fulguration and/or resection of small bladder tumor(s) (0.5 - 2.0 cm) | $217 | 6.49 | N/A | N/A |
| 52235 | Cystourethroscopy, with fulguration and/or resection of medium bladder tumor(s) (2.0 - 5.0 cm) | $255 | 7.62 | N/A | N/A |
| 52240 | Cystourethroscopy, with fulguration and/or resection of large bladder tumor(s) | $344 | 10.3 | N/A | N/A |
“N/A” indicates that Medicare has not deemed this procedure to be reimbursable in this setting.
Hospital Outpatient and ASC Payment - Medicare Unadjusted National Average
| CPT® Code | Code Description | APC | Hospital Outpatient Status Indicator | Hospital Outpatient Medicare Allowed Amount | ASC Medicare Allowed Amount |
|---|---|---|---|---|---|
| Ureteroscopic Stone Management and Stent Insertion | |||||
| 52005 | Cystourethroscopy, with ureteral catheterization | 5373 | J1 | $2,136 | $1,002 |
| 52310 | Cystourethroscopy, with removal of foreign body, calculus, or 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 |
| 52332 | Cystourethroscopy, with insertion of indwelling ureteral stent | 5374 | J1 | $3,601 | $1,723 |
| 52352* | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus | 5374 | J1 | $3,601 | $1,723 |
| 52353* | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy | 5375 | J1 | $5,478 | $2,730 |
| 52356* | Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent | 5375 | J1 | $5,478 | $2,730 |
| PCNL and Associated Procedures | |||||
| 50080* | PCNL or pyelostolithotomy; simple; up to 2 cm | 5376 | J1 | $9,672 | $4,996 |
| 50081* | PCNL or pyelostolithotomy; complex; over 2 cm | 5376 | J1 | $9,672 | $4,996 |
- C-code may be applicable. See page 8 for more information.
| CPT® Code | Code Description | APC | Hospital Outpatient Status Indicator | Hospital Outpatient Medicare Allowed Amount | ASC Medicare Allowed Amount |
|---|---|---|---|---|---|
| PCNL and Associated Procedures, Continued | |||||
| 50430 | Injection procedure for antegrade nephrostogram and/or ureterogram; new access | 5372 | Q2 | $712 | Packaged Procedure |
| 50431 | Injection procedure for antegrade nephrostogram and/or ureterogram; existing access | 5372 | Q2 | $712 | Packaged Procedure |
| 50432 | Placement of nephrostomy catheter, percutaneous | 5373 | J1 | $2,136 | $1,002 |
| 50433 | Placement of nephroureteral catheter, percutaneous, new access | 5374 | J1 | $3,601 | $1,723 |
| 50434 | Convert nephrostomy catheter | 5373 | J1 | $2,136 | $1,002 |
| 50435 | Exchange nephrostomy catheter | 5373 | J1 | $2,136 | $1,002 |
| 50436 | Dilation of existing tract endourologic percutaneous | 5374 | J1 | $3,601 | $1,723 |
| 50437 | Dilation existing tract, new access renal collecting system | 5374 | J1 | $3,601 | $1,723 |
| 50561 | Kidney endoscopy & treatment | 5375 | J1 | $5,478 | $3,655 |
| 50605 | Insert ureteral support | N/A | C | N/A | N/A |
| 50693 | Placement ureteral stent percutaneous | 5374 | J1 | $3,601 | $1,723 |
| 50694 | Placement ureteral stent percutaneous | 5374 | J1 | $3,601 | $1,723 |
| 50695 | Placement ureteral stent percutaneous | 5374 | J1 | $3,601 | $1,723 |
| 74420 | Urography, retrograde, with or without KUB | 5572 | S | $356 | N/A |
| Bladder Stones | |||||
| 52317 | Litholapaxy; simple or small (<2.5 cm) | 5374 | J1 | $3,601 | $1,723 |
| 52318 | Litholapaxy; complicated or large (>2.5 cm) | 5374 | J1 | $3,601 | $1,723 |
| Select Bladder Tumor Procedures | |||||
| 52204 | Cystourethroscopy, with biopsy(s) | 5373 | J1 | $2,136 | $1,002 |
| 52214 | Cystourethroscopy, with fulguration | 5374 | J1 | $3,601 | $1,723 |
| 52224 | Cystourethroscopy, with fulguration or treatment of minor (<0.5 cm) lesion(s) | 5374 | J1 | $3,601 | $1,723 |
| 52234 | Cystourethroscopy, with fulguration and/or resection of small bladder tumor(s) (0.5 - 2.0 cm) | 5374 | J1 | $3,601 | $1,723 |
| 52235 | Cystourethroscopy, with fulguration and/or resection of medium bladder tumor(s) (2.0 - 5.0 cm) | 5374 | J1 | $3,601 | $1,723 |
| 52240 | Cystourethroscopy, with fulguration and/or resection of large bladder tumor(s) | 5375 | J1 | $5,478 | $2,730 |
“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 |
|---|---|---|
| 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 |
| 698 | Other kidney and urinary tract diagnoses with MCC | $12,039 |
| 699 | Other kidney and urinary tract diagnoses with CC | $7,386 |
| 700 | Other kidney and urinary tract diagnoses without CC/MCC | $5,020 |
The patient’s medical record must support the existence and treatment of the complication or co-morbidity
ICD-10 CM Diagnosis Codes
| ICD-10 CM Diagnosis Code | Description |
|---|---|
| Bladder Tumors | |
| C67.0 | Malignant neoplasm of trigone of bladder |
| C67.5 | Malignant neoplasm of bladder neck |
| C67.8 | Malignant neoplasm of overlapping sites of bladder |
| C67.9 | Malignant neoplasm of bladder, unspecified |
| D09.0 | Carcinoma in situ of bladder |
| D30.3 | Benign neoplasm of bladder |
| D41.4 | Neoplasm of uncertain behavior of bladder |
| D49.4 | Neoplasm of unspecified behavior of bladder |
| Bladder and Kidney Stones | |
| N20.0 | Calculs of kidney |
| N20.1 | Calculs of ureter |
| N20.9 | Urinary calculus, unspecified |
| N21.0 | Calculs in bladder |
ICD-10 PCS Procedure Codes
| ICD-10 PCS Procedure Code | Description |
|---|---|
| Bladder Tumors | |
| 0T5C8ZZ | Destruction of Bladder Neck, via Natural or Artificial Opening Endoscopic |
| 0T5B8ZZ | Destruction of Bladder, via Natural or Artificial Opening Endoscopic |
| 0TBB8ZX | Excision of Bladder, via Natural or Artificial Opening Endoscopic, Diagnostic |
| PCNL and Associated Procedures | |
| 0T9030Z | Drainage of Right Kidney with Drainage Device, Percutaneous Approach |
| 0T9040Z | Drainage of Right Kidney with Drainage Device, Percutaneous Endoscopic Approach |
| 0T9130Z | Drainage of Left Kidney with Drainage Device, Percutaneous Approach |
| 0T9140Z | Drainage of Left Kidney with Drainage Device, Percutaneous Endoscopic Approach |
| 0TC03ZZ | Extripation of Matter from Right Kidney, Percutaneous Approach |
| 0TC04ZZ | Extripation of Matter from Right Kidney, Percutaneous Endoscopic Approach |
| 0TC13ZZ | Extripation of Matter from Left Kidney, Percutaneous Approach |
| 0TC14ZZ | Extripation of Matter from Left Kidney, Percutaneous Endoscopic Approach |
| 0TC43ZZ | Extripation of Matter from Left Kidney Pelvis, Percutaneous Approach |
| 0TC44ZZ | Extripation of Matter from Left Kidney Pelvis, Percutaneous Endoscopic Approach |
| 0TF33ZZ | Fragmentation in Right Kidney Pelvis, Percutaneous Approach |
| 0TF43ZZ | Fragmentation in Left Kidney Pelvis, Percutaneous Approach |
| 0TF44ZZ | Fragmentation in Left Kidney Pelvis, Percutaneous Endoscopic Approach |
| 0TF34ZZ | Fragmentation in Right Kidney Pelvis, Percutaneous Endoscopic Approach |
| 0T9300Z | Drainage of Right Kidney Pelvis with Drainage Device, Open Approach |
| 0T9340Z | Drainage of Right Kidney Pelvis with Drainage Device, Percutaneous Endoscopic Approach |
| 0T9430Z | Drainage of Left Kidney Pelvis with Drainage Device, Percutaneous Approach |
| 0T9440Z | Drainage of Left Kidney Pelvis with Drainage Device, Percutaneous Endoscopic Approach |
| 0TC33ZZ | Extripation of Matter from Right Kidney Pelvis, Percutaneous Approach |
| 0TC34ZZ | Extripation of Matter from Right Kidney Pelvis, Percutaneous Endoscopic Approach |
| 0T733DZ | Dilation of Right Kidney Pelvis with Intraluminal Device, Percutaneous Approach |
| 0T734DZ | Dilation of Right Kidney Pelvis with Intraluminal Device, Percutaneous Endoscopic Approach |
| 0T743DZ | Dilation of Left Kidney Pelvis with Intraluminal Device, Percutaneous Approach |
| 0T744DZ | Dilation of Left Kidney Pelvis with Intraluminal Device, Percutaneous Endoscopic Approach |
| Bladder Stones | |
| 0TCB7ZZ | Extripation of Matter from Bladder, Via Natural or Artificial Opening |
| 0TCB8ZZ | Extripation of Matter from Bladder, Via Natural or Artificial Opening Endoscopic |
| 0TFB0ZZ | Fragmentation in Bladder, Open Approach |
| 0TFB3ZZ | Fragmentation in Bladder, Percutaneous Approach |
| 0TFB4ZZ | Fragmentation in Bladder, Percutaneous Endoscopic Approach |
| 0TFB7ZZ | Fragmentation in Bladder, Via Natural or Artificial Opening |
| 0TFB8ZZ | Fragmentation in Bladder, Via Natural or Artificial Opening Endoscopic |
| 0TFC0ZZ | Fragmentation in Bladder Neck, Open Approach |
| 0TFC3ZZ | Fragmentation in Bladder Neck, Percutaneous Approach |
| 0TFC4ZZ | Fragmentation in Bladder Neck, Percutaneous Endoscopic Approach |
| 0TFC7ZZ | Fragmentation in Bladder Neck, Via Natural or Artificial Opening |
| ICD-10PCS Procedure Code | Description |
|---|---|
| Bladder Stones, continued | |
| 0TFC8ZZ | Fragmentation in Bladder Neck, Via Natural or Artificial Opening Endoscopic |
| 0T9B7ZZ | Drainage of Bladder, Via Natural or Artificial Opening |
| 0T9B8ZZ | Drainage of Bladder, Via Natural or Artificial Opening Endoscopic |
| 0T9C7ZZ | Drainage of Bladder Neck, Via Natural or Artificial Opening |
| 0T9C8ZZ | Drainage of Bladder Neck, Via Natural or Artificial Opening Endoscopic |
| 0TCC7ZZ | Extirpation of Matter from Bladder Neck, Via Natural or Artificial Opening |
| 0TCC8ZZ | Extirpation of Matter from Bladder Neck, Via Natural or Artificial Opening Endoscopic |
| Ureteroscopy | |
| 0TC37ZZ | Extirpation of Matter from Right Kidney Pelvis, Via Natural or Artificial Opening |
| 0TC38ZZ | Extirpation of Matter from Right Kidney Pelvis, Via Natural or Artificial Opening Endoscopic |
| 0TC47ZZ | Extirpation of Matter from Left Kidney Pelvis, Via Natural or Artificial Opening |
| 0TC48ZZ | Extirpation of Matter from Left Kidney Pelvis, Via Natural or Artificial Opening Endoscopic |
| 0TC67ZZ | Extirpation of Matter from Right Ureter, Via Natural or Artificial Opening |
| 0TC68ZZ | Extirpation of Matter from Right Ureter, Via Natural or Artificial Opening Endoscopic |
| 0TC77ZZ | Extirpation of Matter from Left Ureter, Via Natural or Artificial Opening |
| 0TC78ZZ | Extirpation of Matter from Left Ureter, Via Natural or Artificial Opening Endoscopic |
| 0TC68ZZ | Extirpation of Matter from Right Ureter, Via Natural or Artificial Opening Endoscopic |
| 0TC77ZZ | Extirpation of Matter from Left Ureter, Via Natural or Artificial Opening |
| 0TC78ZZ | Extirpation of Matter from Left Ureter, Via Natural or Artificial Opening Endoscopic |
| 0T768DZ | Dilation of Right Ureter with Intraluminal Device, Via Natural or Artificial Opening Endoscopic |
| 0T778DZ | Dilation of Left Ureter with Intraluminal Device, Via Natural or Artificial Opening Endoscopic |
| 0T788DZ | Dilation of Bilateral Ureters with Intraluminal Device, Via Natural or Artificial Opening Endoscopic |
| 0TF38ZZ | Fragmentation in Right Kidney Pelvis, Via Natural or Artificial Opening Endoscopic |
| 0TF48ZZ | Fragmentation in Left Kidney Pelvis, Via Natural or Artificial Opening Endoscopic |
| 0TF68ZZ | Fragmentation in Right Ureter, Via Natural or Artificial Opening Endoscopic |
| 0TF78ZZ | Fragmentation in Left Ureter, Via Natural or Artificial Opening Endoscopic |
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 |
| C1747 | N (packaged)* | Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable) |
*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.
- 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.
- 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.
Medicare follows NUBC guidelines.¹ The UB-04 Editor includes the revenue code 0278 for use with C1747.²
Suggested Revenue Code for Device Codes C1889
| Code | Description |
|---|---|
| 0278¹ | 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 |
CPT® Codes with Long Descriptions, continued
| CPT® Code | Long Description, continued |
|---|---|
| 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 |
| 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 |
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-pps-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/P0001.html
- https://www.govinfo.gov/content/pkg/FR-2010-11-24/pdf/2010-27926.pdf Page 26 Accessed November 25, 2024.
Uniform Billing Editor Numeric List of CPT/HCPCS Codes
| CPT/HCPCS | Revenue Code |
|---|---|
| C1734-C1748 | 0272, 0278 |
November 2025 © 2025 Optum360, LLC CPT © 2024 American Medical Association. All Rights Reserved. Copyright 2024, American Hospital Association (“AHA”) VII-291
† According to Medicare, devices do not need to remain in the body to be classified as “implants.” 3,4
-
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.
| AVSD — Shunt for dialysis - Arteriovenostomy for renal dialysis | |||
|---|---|---|---|
| Procedure Code Category | CPT Codes | Code Description | Code Status |
| AVSD | 36800 | Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to vein | No change |
| AVSD | 36810 | Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external (Scribner type) | No change |
| AVSD | 36815 | Insertion of cannula for hemodialysis, other purpose (separate procedure); arteriovenous, external revision, or closure | No change |
| AVSD | 36818 | arteriovenous anastomosis, open; by upper arm cephalic vein transposition | No change |
| AVSD | 36819 | Arteriovenous anastomosis, open; by upper arm basilic vein transposition | No change |
| AVSD | 36820 | Arteriovenous anastomosis, open; by forearm vein transposition | No change |
| AVSD | 36821 | Arteriovenous anastomosis, open; direct, any site (e.g., Cimino type) (separate procedure) | No change |
| AVSD | 36825 | Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft | No change |
| AVSD | 36830 | Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); non autogenous graft | No change |
| AVSD | 36832 | Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure) | No change |
| AVSD | 36833 | Revision, open, arteriovenous fistula; with thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure) | No change |
| AVSD | 36838 | Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome) | No change |
| KTP — Kidney transplant - Transplantation of kidney | |||
|---|---|---|---|
| Procedure Code Category | CPT Codes | Code Description | Code Status |
| KTP | 50340 | Recipient Urology - Nephrectomy (Kidney Removal) (separate procedure) | No change |
| KTP | 50360 | Renal allotransplantation, implantation of graft; without recipient nephrectomy | No change |
| KTP | 50365 | Renal allotransplantation, implantation of graft; with recipient nephrectomy | No change |
| KTP | 50380 | Renal autotransplantation, reimplantation of kidney | No change |
| NEPH — Kidney surgery - Resection or manipulation of the kidney with or without removal of related structures | ||||
|---|---|---|---|---|
| Procedure Code Category | CPT Codes | Code Description | Code Status | |
| NEPH | 50010 | Renal exploration, not necessitating other specific procedures | No change | |
| NEPH | 50020 | Drainage of perirenal or renal abscess, open | No change | |
| NEPH | 50040 | Nephrostomy, nephrotomy with drainage | No change | |
| NEPH | 50045 | Nephrotomy, with exploration | No change | |
| NEPH | 50060 | nephrolithotomy; removal of calculus | No change | |
| NEPH | 50065 | Nephrolithotomy; secondary surgical operation for calculus | No change | |
| NEPH | 50070 | Nephrolithotomy; complicated by congenital kidney abnormality | No change | |
| NEPH | 50075 | Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy) | No change | |
| NEPH | 50120 | Pyelotomy; with exploration | No change | |
| NEPH | 50125 | Pyelotomy; with drainage, pyelostomy | No change | |
| NEPH | 50130 | Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy) | No change | |
| NEPH | 50205 | Renal biopsy; by surgical exposure of kidney | No change | |
| NEPH | 50220 | nephrectomy, including partial ureterectomy, any open approach including rib resection; | No change | |
| NEPH | 50225 | nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney | No change | |
| NEPH | 50230 | Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy | No change | |
| NEPH | 50234 | Nephrectomy with total ureterectomy and bladder cuff; through same incision | No change | |
| NEPH | 50236 | Nephrectomy with total ureterectomy and bladder cuff; through separate incision | No change | |
| NEPH | 50240 | nephrectomy, partial | No change | |
| NEPH | 50250 | Ablation, open, 1 or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound guidance and monitoring, if performed | No change | |
| NEPH | 50280 | Excision or unroofing of cyst(s) of kidney | No change | |
| NEPH | 50290 | Excision of perinephric cyst | No change | |
| NEPH | 50320 | Donor nephrectomy (including cold preservation); open, from living donor | No change | |
| NEPH | 50400 | Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple | No change | |
| NEPH | 50405 | pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty) | No change | |
| NEPH | 50541 | Laparoscopy, surgical; ablation of renal cysts | No change | |
| NEPH | 50542 | Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed | No change | |
| NEPH | 50543 | Laparoscopy, surgical; partial nephrectomy | No change | |
| NEPH | 50545 | Laparoscopy, surgical; radical Urology - Nephrectomy (Kidney Removal) (includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy) | No change | |
| NEPH | 50546 | Laparoscopy, surgical; nephrectomy, including partial ureterectomy | No change | |
| NEPH | 50547 | Laparoscopy, surgical; donor nephrectomy (including cold preservation), from living donor | No change | |
| NEPH | 50548 | Laparoscopy, surgical; nephrectomy with total ureterectomy | No change | |
| NEPH | 50549 | Unlisted laparoscopic nephrectomy | No change |
| PRST — Prostate surgery - Suprapubic, retropubic, radical, or perineal excision of the prostate; does not include transurethral resection of the prostate | |||
|---|---|---|---|
| Procedure Code Category | CPT Codes | Code Description | Code Status |
| PRST | 55705 | Biopsy, prostate; incisional, any approach | No change |
| PRST | 55810 | Prostatectomy, perineal radical | No change |
| PRST | 55812 | Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic lymphadenectomy) | No change |
| PRST | 55815 | Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes | No change |
| PRST | 55821 | Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages | No change |
| PRST | 55831 | Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); retropubic, subtotal | No change |
| PRST | 55840 | Prostatectomy, retropubic radical, with or without nerve sparing; | No change |
| PRST | 55842 | Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy) | No change |
| PRST | 55845 | Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes | No change |
| PRST | 55866 | Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed | No change |
| PRST | 55867 | Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed | No change |
| PRST | 55868 | Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with lymph node biopsy(ies) (limited pelvic lymphadenectomy) | Added |
| PRST | 55869 | Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes | Added |