CPT code 50974: Ureteroscopy, biopsy during ureteroscopy2026 Medicare rate & RVUs in Illinois
Reports endoscopic inspection of the ureter with tissue sampling, commonly to evaluate a suspicious urothelial lesion or other abnormal ureteral tissue.
CMS doesn’t publish an office rate for 50974 in Illinois.
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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What 50974 covers
A urologist passes an endoscope through the bladder into the ureter, inspects the ureteral lining, and obtains tissue for examination. The service is used when imaging or clinical findings raise concern for a ureteral lesion, including possible upper urinary tract malignancy. It is generally performed in an operating or procedure setting, with the sampled site and tissue submitted for pathologic evaluation.
Report this code when ureteroscopy includes biopsy; inspection alone or catheter placement alone describes a different service. The operative note should identify the side, the ureteral site examined, the abnormality sampled, and the biopsy performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. For a bilateral procedure, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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 50974 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $465.72 |
| East St. Louis, IL | Unavailable | $446.31 |
| Rest of Illinois | Unavailable | $428.45 |
| Suburban Chicago, IL | Unavailable | $447.32 |
How the 50974 rate is calculated
Each of 50974’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 · 50974
RVUs × geographic indexes × conversion factor
Work8.93
8.93 RVUs× 1.000 GPCI
Practice expense2.30
2.30 RVUs× 1.000 GPCI
Malpractice1.15
1.15 RVUs× 1.000 GPCI
Adjusted RVUs
12.3800
Conversion factor
$33.4009
Medicare rate
$413.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 50974
The CMS indicators that decide how 50974 is paid alongside other services.
CMS payment indicators · 50974
Ureteroscopy, biopsy during ureteroscopy
| 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
50974 without 50 · national facility
$413.50
Ureteroscopy, biopsy during ureteroscopy
50974-50 · Bilateral: 150%
$620.25
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).
50974 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 50970Ureter endoscopyEndoscopic examination
- 50970 describes diagnostic ureteroscopy without biopsy. Choose 50974 when tissue is sampled during the examination.
- 50972UreteroscopyWith catheter insertion
- 50972 includes ureteral catheter placement; 50974 is the biopsy service. The operative note should support the service actually performed.
- 50976UreteroscopyTherapeutic procedure
- 50976 represents ureteroscopy with treatment, while 50974 represents ureteroscopy with tissue sampling. Distinguish biopsy from therapeutic work in the operative record.
50974 billing questions
When should 50974 be chosen over diagnostic ureteroscopy?
Use 50974 when the ureteroscopic examination includes tissue sampling. Diagnostic ureteroscopy without biopsy is represented by 50970.
Is biopsy included in the procedure?
Yes. The tissue sampling performed during ureteroscopy is part of 50974; do not report the biopsy as a separate procedure.
How should bilateral ureteroscopic biopsies be reported?
For a bilateral procedure, report modifier 50. CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 50974?
Document the ureteroscopic examination, laterality and site, the abnormal tissue or lesion, and that tissue was obtained for biopsy.
What happens when another related endoscopy is performed in the same session?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The operative documentation should identify each service performed.
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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