Payment Guide for CPT CODE 52005, 52234, AND 52240

Urinary and Male Genital Systems (Codes 50010 - 55899)

A. Cystourethroscopy With Ureteral Catheterization (Code 52005)

Code 52005 has a zero in the bilateral field (payment adjustment for bilateral procedure does not apply) because the basic procedure is an examination of the bladder and urethra (cystourethroscopy), which are not paired organs. The work RVUs assigned take into account that it may be necessary to examine and catheterize one or both ureters. No additional payment is made when the procedure is billed with bilateral modifier “-50.” Neither is any additional payment made when both ureters are examined and code 52005 is billed with multiple surgery modifier “-51.” It is inappropriate to bill code 52005 twice, once by itself and once with modifier “-51,” when both ureters are examined.

B. Cystourethroscopy With Fulgration and/or Resection of Tumors (Codes 52234, 52235, and 52240)

The descriptors for codes 52234 through 52240 include the language “tumor(s).”

This means that regardless of the number of tumors removed, only one unit of a single code can be billed on a given date of service. It is inconsistent to allow payment for removal of a small (code 52234) and a large (code 52240) tumor using two codes when only one code is allowed for the removal of more than one large tumor. For these three codes only one unit may be billed for any of these codes, only one of the codes may be billed, and the billed code reflects the size of the largest tumor removed.

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