CPT code 51065: Ureteral stone removal, operative removal2026 Medicare rate & RVUs in Illinois
Reports operative removal of a ureteral calculus when the surgeon performs a ureterolithotomy rather than endoscopic extraction or stone fragmentation.
CMS doesn’t publish an office rate for 51065 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.
Your location
On this page 9 sections
What 51065 covers
A urologist performs an operative ureterolithotomy to remove a calculus lodged in the ureter. The service addresses a ureteral stone requiring surgical access and removal, rather than a stone in the bladder or one treated by endoscopic extraction or fragmentation. It is generally performed in a hospital operating room or another surgical facility.
Report the code when the operative note supports removal of a ureteral calculus by the procedure represented by this code. Document the stone’s ureteral location, the operative approach, and the work performed to remove it; distinguish the service from endoscopic ureteroscopic treatment and bladder stone removal. This is major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. 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 51065 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 | $587.23 |
| East St. Louis, IL | Unavailable | $559.26 |
| Rest of Illinois | Unavailable | $539.28 |
| Suburban Chicago, IL | Unavailable | $569.01 |
How the 51065 rate is calculated
Each of 51065’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 · 51065
RVUs × geographic indexes × conversion factor
Work9.70
9.70 RVUs× 1.000 GPCI
Practice expense4.92
4.92 RVUs× 1.000 GPCI
Malpractice1.25
1.25 RVUs× 1.000 GPCI
Adjusted RVUs
15.8700
Conversion factor
$33.4009
Medicare rate
$530.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 51065
51065 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 51065
Ureteral stone removal, operative removal
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
| 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 · 51065
Ureteral stone removal, operative removal
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 51 · payment effect
With and without the modifier
51065 without 51 · national facility
$530.07
Ureteral stone removal, operative removal
51065-51 · Second procedure: 50%
$265.04
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
51065 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 51060UreterolithotomyOpen ureteral incision
- Both codes concern operative removal of a ureteral calculus. Choose based on the exact procedure documented and the distinctions in the full code descriptors, not just the presence of a ureteral stone.
- 51050Bladder stone removalOpen cystolithotomy
- Use 51050 for a bladder calculus. This code is for a calculus located in the ureter.
- 52352UreteroscopyStone removal or manipulation
- Use 52352 when the surgeon extracts the stone through a ureteroscopic or pyeloscopic approach; this code represents operative ureteral stone removal.
- 52353Stone lithotripsyUreteroscopy or pyeloscopy
- Use 52353 for endoscopic fragmentation of a ureteral or renal calculus. This code represents operative removal rather than endoscopic fragmentation.
51065 billing questions
How does this differ from ureteroscopic stone removal?
This code represents operative ureteral stone removal. Use an endoscopic ureteroscopy code when the surgeon accesses and treats the stone endoscopically instead.
Can bladder stone removal be reported instead?
No. Code 51050 is for a calculus in the bladder; this code concerns a calculus in the ureter.
Is modifier 50 appropriate for stones on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
Fee sheets · Coming soon
Put 51065 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist