Adopted Regulation February 18, 2010



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1,376.35

Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

49657

1,376.35

Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

50200

320.09

Renal biopsy; percutaneous, by trocar or needle

50382

929.48

Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

50384

682.69

Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation

50385

682.69

Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50386

261.93

Removal (via snare/capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation

50387

566.67

Removal and replacement of externally accessible transnephric ureteral stent (e.g., external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation

50389

261.93

Removal of nephrostomy tube, requiring fluoroscopic guidance (e.g., with concurrent indwelling ureteral stent)

50390

320.09

Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous

50391

37.91

Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (e.g., anticarcinogenic or antifungal agent)

50392

487.46

Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

50393

610.86

Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous

50395

487.46

Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, percutaneous

50396

91.66

Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

50398

429.45

Change of nephrostomy or pyelostomy tube

50551

277.08

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50553

610.86

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50555

277.08

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50557

610.86

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50561

610.86

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

50562

261.93

Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with resection of tumor

50570

261.93

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50572

261.93

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50574

261.93

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50575

1,302.88

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

50576

682.69

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50580

682.69

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

50590

1,522.06

Lithotripsy, extracorporeal shock wave

50592

1,689.21

Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency

50686

37.91

Manometric studies through ureterostomy or indwelling ureteral catheter

50688

429.45

Change of ureterostomy tube or externally accessible ureteral stent via ileal conduit

50947

1,428.92

Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent placement

50948

1,428.92

Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent placement

50951

277.08

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50953

277.08

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50955

610.86

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50957

610.86

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50961

610.86

Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

50970

277.08

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

50972

277.08

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter

50974

487.46

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with biopsy

50976

487.46

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy

50980

610.86

Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus

51020

741.19

Cystotomy or cystostomy; with fulguration and/or insertion of radioactive material

51030

741.19

Cystotomy or cystostomy; with cryosurgical destruction of intravesical lesion

51040

741.19

Cystostomy, cystotomy with drainage

51045

306.14

Cystotomy, with insertion of ureteral catheter or stent (separate procedure)

51050

741.19

Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection

51065

741.19

Cystotomy, with calculus basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus

51080

498.25

Drainage of perivesical or prevesical space abscess

51100

28.89

Aspiration of bladder; by needle

51101

37.91

Aspiration of bladder; by trocar or intracatheter

51102

510.00

Aspiration of bladder; with insertion of suprapubic catheter

51500

851.54

Excision of urachal cyst or sinus, with or without umbilical hernia repair

51520

741.19

Cystotomy; for simple excision of vesical neck (separate procedure)

51700

49.34

Bladder irrigation, simple, lavage and/or instillation

51701

23.47

Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)

51702

23.47

Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)

51703

37.91

Insertion of temporary indwelling bladder catheter; complicated (e.g., altered anatomy, fractured catheter/balloon)

51705

67.91

Change of cystostomy tube; simple

51710

429.45

Change of cystostomy tube; complicated

51715

779.76

Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck

51720

54.53

Bladder instillation of anticarcinogenic agent (including retention time)

51725

104.76

Simple cystometrogram (CMG) (e.g., spinal manometer)

51726

144.30

Complex cystometrogram (e.g., calibrated electronic equipment)

51736

19.80

Simple uroflowmetry (UFR) (e.g., stop-watch flow rate, mechanical uroflowmeter)

51741

23.05

Complex uroflowmetry (e.g., calibrated electronic equipment)

51772

91.66

Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique

51784

37.91

Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique

51785

63.32

Needle electromyography studies (EMG) of anal or urethral sphincter, any technique

51792

37.91

Stimulus evoked response (e.g., measurement of bulbocavernosus reflex latency time)

51795

67.91

Voiding pressure studies (VP); bladder voiding pressure, any technique

51797

67.91

Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal)

51798

16.88

Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging

51880

610.86

Closure of cystostomy (separate procedure)

51992

1,156.00

Laparoscopy, surgical; sling operation for stress incontinence (e.g., fascia or synthetic)

52000

277.08

Cystourethroscopy (separate procedure)

52001

516.52

Cystourethroscopy with irrigation and evacuation of multiple obstructing clots

52005

537.04

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

52007

660.45

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

306.14

Cystourethroscopy, with ejaculatory duct catheterization, with or without irrigation, instillation, or duct radiography, exclusive of radiologic service

52204

537.04

Cystourethroscopy, with biopsy(s)

52214

660.45

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands

52224

660.45

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy

52234

660.45

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

52235

688.53

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm)

52240

688.53

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s)

52250

741.19

Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration



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