CPT code 50955: Ureteroscopy, with biopsy2026 Medicare rate & RVUs in Michigan
Reports endoscopic examination of the ureter with tissue sampling, such as biopsy of a suspicious ureteral lesion during a facility-based procedure.
Medicare pays $430.81–$456.83 for 50955 in the office in Michigan, from Rest of Michigan to Detroit, MI. 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 50955 covers
A urologist passes an endoscope into the ureter to inspect its lining and obtain tissue from a finding that needs pathologic evaluation. A typical clinical situation is sampling a suspicious upper-tract urothelial lesion. The service is commonly performed in a hospital or ambulatory surgery setting; Medicare recorded facility services for this code in 2024.
Report the code when the documented ureteroscopic service includes biopsy, and support it with the indication, ureter and side examined, endoscopic findings, and tissue-sampling details. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral procedures, modifier 50 is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; 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 50955 pays more and less in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | $456.83 | $326.94 |
| Rest of Michigan | $430.81 | $307.91 |
How the 50955 rate is calculated
Each of 50955’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 · 50955
RVUs × geographic indexes × conversion factor
Work6.57
6.57 RVUs× 1.000 GPCI
Practice expense5.88
5.88 RVUs× 1.000 GPCI
Malpractice0.85
0.85 RVUs× 1.000 GPCI
Adjusted RVUs
13.3000
Conversion factor
$33.4009
Medicare rate
$444.23
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50955
The CMS indicators that decide how 50955 is paid alongside other services.
CMS payment indicators · 50955
Ureteroscopy, with biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
50955 without 50 · national office
$444.23
Ureteroscopy, with biopsy
50955-50 · Bilateral: 150%
$666.35
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).
50955 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50951UreteroscopyDiagnostic examination
- 50951 represents diagnostic ureteroscopy. Choose 50955 when the documented ureteroscopic service also includes biopsy.
- 50957UreteroscopyEndoscopic lesion treatment
- 50957 is a ureteroscopic treatment code. This code is for ureteroscopy with biopsy rather than treatment-focused work.
- 50974UreteroscopyBiopsy during ureteroscopy
- Both short descriptors identify ureteroscopic biopsy. Compare the full CPT descriptors and operative documentation to determine which service configuration was performed.
50955 billing questions
When should this code be selected instead of diagnostic ureteroscopy?
Use this code when the ureteroscopic service includes biopsy. A diagnostic-only examination without tissue sampling is represented by a diagnostic ureteroscopy code, such as 50951.
Can the biopsy be reported separately from the ureteroscopy?
This code describes ureteroscopy with biopsy. The record should show the endoscopic examination and tissue sampling; do not treat the biopsy as an unrelated service merely because a specimen is sent to pathology.
How does CMS handle related endoscopies performed together?
Endoscopy family pricing applies when related endoscopies are performed together. The code’s payment is subject to that family pricing in the combined service.
How is a bilateral procedure reported?
For a bilateral procedure, report modifier 50; CMS pays the procedure at 150%. Document the ureteral work on both sides.
What assistant or co-surgeon rules apply?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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
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