CPT code 50590: Kidney stone treatment, shock-wave lithotripsy2026 Medicare rate & RVUs in Pennsylvania
Reports external shock-wave treatment to fragment a kidney stone, typically performed by a urologist without endoscopic or percutaneous stone access.
Medicare pays $725.08–$790.30 for 50590 in the office in Pennsylvania, from Rest of Pennsylvania to Metropolitan Philadelphia, PA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 50590 covers
This service uses externally generated shock waves, directed toward a renal calculus, to break it into smaller pieces. A urologist typically performs the treatment in a hospital or ambulatory setting, using imaging to locate and target the stone. Unlike endoscopic or percutaneous stone procedures, treatment does not require access through the urinary tract or a percutaneous tract to reach the stone.
Report the service when the documented procedure is shock-wave fragmentation of a kidney stone. The record should support the treated kidney and the use of this treatment method. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral treatment, modifier 50 is paid at 150%. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 50590 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | $790.30 | $541.34 |
| Rest of Pennsylvania | $725.08 | $505.54 |
How the 50590 rate is calculated
Each of 50590’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 50590
RVUs × geographic indexes × conversion factor
Work9.53
9.53 RVUs× 1.000 GPCI
Practice expense12.00
12.00 RVUs× 1.000 GPCI
Malpractice1.23
1.23 RVUs× 1.000 GPCI
Adjusted RVUs
22.7600
Conversion factor
$33.4009
Medicare rate
$760.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50590
50590 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 50590
Kidney stone treatment, shock-wave lithotripsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.08/0.83/0.09 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 50590
Kidney stone treatment, shock-wave lithotripsy
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50590 without 50 · national office
$760.20
Kidney stone treatment, shock-wave lithotripsy
50590-50 · Bilateral: 150%
$1,140.30
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
50590 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52353Stone lithotripsyUreteroscopy or pyeloscopy
- Use 50590 for external shock-wave treatment of a kidney stone. Use 52353 when a ureteroscope is advanced through the urinary tract to fragment a stone.
- 50080Percutaneous stone removalSimple, up to 2 cm
- 50590 fragments a kidney stone with externally applied shock waves. 50080 involves percutaneous access and stone fragmentation for a simple case.
- 50081Kidney stone removalStone burden over 2 cm
- 50590 uses external shock waves. 50081 is for complex percutaneous stone removal with fragmentation, using access through a percutaneous tract.
50590 billing questions
How does this differ from ureteroscopic stone treatment?
This code is for externally delivered shock waves directed at a kidney stone. Ureteroscopic treatment uses an endoscope passed through the urinary tract to reach and treat a stone.
Does the global period include routine follow-up?
Yes. The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
How is bilateral treatment reported?
When both kidneys are treated, report modifier 50; CMS pays the bilateral procedure at 150%.
How does the multiple-procedure reduction affect payment?
When procedures are performed in the same session, CMS pays the highest-valued procedure in full and the others at 50%.
Can an assistant or co-surgeon be reported?
CMS does not pay assistant-at-surgery services for this code. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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