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CPT code 52204: Cystoscopic biopsy, bladder tissue sampling2026 Medicare rate & RVUs in Puerto Rico

A urologist uses cystoscopy to collect bladder tissue for pathology when a visible abnormality or selected area needs histologic evaluation.

CMS RVU26DEffective Oct 1, 2026One payment locality26.1K Medicare services in 2024

In Puerto Rico, Medicare pays $358.07 for 52204 in the office and $127.09 when it’s performed in a hospital or facility.

$358.07Office (non-facility)
$127.09Hospital or facility
+0.8%vs the national office rate ($355.39)

Check a contract rate as a % of Medicare · 52204 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 52204 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 52204 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 52204 covers

A urologist passes a cystoscope through the urethra into the bladder, inspects the lining, and collects one or more tissue samples, commonly from a suspicious mucosal lesion. The samples are submitted for pathologic examination. The procedure may be performed in an office or a facility, depending on the patient and clinical circumstances.

Report 52204 for cystoscopic tissue sampling, rather than inspection alone or a session that treats a lesion by fulguration or resection. The operative note should identify the sampled site or sites and the reason for biopsy; report the procedure once, not by specimen count. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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.

How Puerto Rico compares for 52204

Across 109 of 109 payment localities, the office rate for 52204 runs from $313.28 in Arkansas to $474.12 in San Benito County, CA. Puerto Rico pays $358.07. The RVUs are the same everywhere; the geographic indexes change the dollars.

52204 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$358.07
  2. Los Angeles, CA · California$402.53+$44.46
  3. Washington, DC area · District of Columbia$407.43+$49.36
  4. Miami, FL · Florida$383.39+$25.32
  5. Chicago, IL · Illinois$371.98+$13.91
  6. Manhattan, NY · New York$409.49+$51.42
  7. Alaska · Alaska$409.41+$51.34

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

52204 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$318.02$118.11
ArkansasArkansas$313.28$117.04
ArizonaArizona$345.70$124.33
Bakersfield, CACalifornia$377.47$127.07
Chico, CACalifornia$376.47$126.07
El Centro, CACalifornia$376.52$126.13
Fresno, CACalifornia$376.47$126.07
Hanford, CACalifornia$376.47$126.07

52204 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$313.28

$425.30

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
52204 office rate range by state
State / territoryOffice rate rangeLocalities
AK$409.411
AL$318.021
AR$313.281
AZ$345.701
CA$376.47–$474.1229
CO$370.521
CT$379.441
DC$407.431
DE$351.551
FL$349.68–$383.393
GA$329.54–$362.072
GU$386.161
HI$386.161
IA$326.481
ID$328.641
IL$339.20–$371.984
IN$330.601
KS$324.841
KY$325.611
LA$325.06–$341.622
MA$368.19–$407.952
MD$358.41–$407.433
ME$330.33–$348.862
MI$334.27–$354.092
MN$354.921
MO$319.28–$342.953
MS$316.351
MT$355.361
NC$333.901
ND$348.641
NE$328.341
NH$364.611
NJ$383.74–$403.012
NM$336.131
NV$353.751
NY$339.04–$419.585
OH$332.901
OK$325.081
OR$350.97–$382.642
PA$333.48–$369.742
PR$358.071
RI$364.331
SC$333.961
SD$347.841
TN$326.511
TX$331.22–$369.318
UT$338.661
VA$347.63–$407.432
VI$358.071
VT$347.181
WA$367.52–$416.442
WI$336.631
WV$326.281
WY$352.431

See 52204 in every payment locality

How the 52204 rate is calculated

Each of 52204’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 · 52204

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.53

2.53 RVUs× 1.000 GPCI

Practice expense7.77

7.77 RVUs× 1.000 GPCI

Malpractice0.34

0.34 RVUs× 1.000 GPCI

Adjusted RVUs

10.6400

Conversion factor

$33.4009

Medicare rate

$355.39

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

6,111

Code
52204
Physician work
2.53
Practice expense
7.77
Malpractice
0.34

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 52204 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.53× 1.0002.5300
Practice expense7.77× 1.0117.8555
Malpractice0.34× 0.9850.3349
Total RVUs10.7204
Conversion factor× 33.4009

Office rate, Puerto Rico$358.07

Office: (2.53 × 1 + 7.77 × 1.011 + 0.34 × 0.985) × $33.4009 = $358.07

Facility: (2.53 × 1 + 0.93 × 1.011 + 0.34 × 0.985) × $33.4009 = $127.09

Open 52204 in the RVU calculator

Payment rules and modifiers for 52204

The CMS indicators that decide how 52204 is paid alongside other services.

CMS payment indicators · 52204

Cystoscopic biopsy, bladder tissue sampling

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

52204 without 51 · national office

$355.39

Cystoscopic biopsy, bladder tissue sampling

52204-51 · Second procedure: 50%

$177.70

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%).

When to use modifier 51

Codes related to 52204

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 52204
CodeHow it relatesOffice range, Puerto Rico
Used instead
52214Cystoscopy treatment, fulguration at specified sitesFor cystoscopic treatment at specified lower urinary tract sites rather than tissue sampling.$733.85
52224Bladder lesion treatment, lesions under 0.5 cmFor cystoscopic treatment of bladder lesions rather than biopsy for tissue diagnosis.$766.69
52234Bladder tumor treatment, tumor 0.5 to 2.0 cmFor cystoscopic treatment or resection of small bladder tumors rather than tissue sampling.No office rate
52235Bladder tumor resection, medium, 2.0–5.0 cmFor cystoscopic treatment or resection of medium bladder tumors rather than tissue sampling.No office rate
52240Bladder tumor treatment, large tumor categoryFor cystoscopic treatment or resection of large bladder tumors rather than tissue sampling.No office rate

How 52204 has changed in Puerto Rico

52204 · Office / nonfacility

$358.07

Effective 2026-10-01

The base rate is $13.30 higher than on 2025-10-01, moving from $344.77 to $358.07 (3.9%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $344.77changed to$358.07

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.59 changed to 2.53
    • Practice expense RVU 7.72 changed to 7.77
    • Malpractice RVU 0.30 changed to 0.34
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $378.25changed to$344.77

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.40 changed to 7.72
    • Malpractice RVU 0.32 changed to 0.30

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $372.07changed to$378.25

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $386.75changed to$372.07

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.46 changed to 8.40
    • Malpractice RVU 0.30 changed to 0.32
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $384.62changed to$386.75

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $401.25changed to$384.62

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.63 changed to 8.46
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $410.21changed to$401.25

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.80 changed to 8.63
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $398.11changed to$410.21

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.08 changed to 8.80
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $391.48changed to$398.11

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.94 changed to 8.08
    • Malpractice RVU 0.28 changed to 0.30
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $384.89changed to$391.48

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.76 changed to 7.94
    • Malpractice RVU 0.29 changed to 0.28

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $333.73changed to$384.89

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.62 changed to 7.76
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $286.35changed to$333.73

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.55 changed to 7.62
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $287.24changed to$286.35

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.54 changed to 7.55
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $285.81changed to$287.24

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $278.15changed to$285.81

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.38 changed to 7.54
    • Malpractice RVU 0.25 changed to 0.30
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $275.55changed to$278.15

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.03 changed to 7.38
    • Malpractice RVU 0.26 changed to 0.25
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $275.55

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$358.07$127.09RVU26D
2026-07-01$358.07$127.09RVU26C
2026-04-01$358.07$127.09RVU26B
2026-01-01$358.07$127.09RVU26A
2025-10-01$344.77$136.30RVU25D
2025-07-01$344.77$136.30RVU25C
2025-04-01$344.77$136.30RVU25B
2025-01-01$344.77$136.30RVU25A
2024-10-01$378.25$139.58RVU24D
2024-07-01$378.25$139.58RVU24C
2024-04-01$378.25$139.58RVU24B
2024-03-09$378.25$139.58RVU24AR
2024-01-01$372.07$137.30RVU24A
2023-10-01$386.75$139.79RVU23D
2023-07-01$384.62$139.62RVU23C
2023-04-01$384.62$139.62RVU23B
2023-01-01$384.62$139.62RVU23A
2022-10-01$401.25$142.07RVU22D
2022-07-01$401.25$142.07RVU22C
2022-04-01$401.25$142.07RVU22B
2022-01-01$401.25$142.07RVU22A
2021-10-01$410.21$142.90RVU21D
2021-07-01$410.21$142.90RVU21C
2021-04-01$410.21$142.90RVU21B
2021-01-01$410.21$142.90RVU21A
2020-10-01$398.11$147.10RVU20D
2020-07-01$398.11$147.10RVU20C
2020-04-01$398.11$147.10RVU20B
2020-01-01$398.11$147.10RVU20A
2019-10-01$391.48$147.24RVU19D
2019-07-01$391.48$147.24RVU19C
2019-04-01$391.48$147.24RVU19B
2019-01-01$391.48$147.24RVU19A
2018-10-01$384.89$148.16RVU18D
2018-07-01$384.89$148.16RVU18C
2018-04-01$384.89$148.16RVU18B
2018-01-01$384.89$148.16RVU18AR1
2017-10-01$333.73$137.11RVU17D
2017-07-01$333.73$137.11RVU17C
2017-04-01$333.73$137.11RVU17B
2017-01-01$333.73$137.11RVU17A
2016-10-01$286.35$126.07RVU16D
2016-07-01$286.35$126.07RVU16C
2016-04-01$286.35$126.07RVU16B
2016-01-01$286.35$126.07RVU16A
2015-10-01$287.24$126.63RVU15D
2015-07-01$287.24$126.63RVU15C
2015-04-01$285.81$126.00RVU15B
2015-01-01$285.81$126.00RVU15A
2014-10-01$278.15$124.71RVU14D
2014-07-01$278.15$124.71RVU14C
2014-04-01$278.15$124.71RVU14B
2014-01-01$278.15$124.71RVU14A
2013-10-01$275.55$119.16RVU13D
2013-07-01$275.55$119.16RVU13C
2013-04-01$275.55$119.16RVU13B
2013-01-01$275.55$119.16RVU13AR

Price 52204 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

52204 billing questions

When is 52204 appropriate instead of a treatment code?

Use 52204 when cystoscopy is used to obtain tissue for examination. When the session treats a lesion by fulguration or resection instead, select the code that describes that treatment.

Is 52204 reported once for each biopsy specimen?

No. Report the procedure once for the cystoscopic biopsy session, not once per specimen. Document the sampled site or sites and the clinical reason for sampling.

How does 52204 differ from diagnostic cystoscopy?

A diagnostic cystoscopy involves inspection without tissue sampling. Report 52204 when the cystoscopic procedure includes biopsy.

Can modifier 50 be used for biopsies from both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not used.

What happens when related endoscopies are performed in the same session?

CMS endoscopy-family pricing applies when related endoscopies are performed together. The same-day preoperative and postoperative care is included in the 0-day global period.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery 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
RVUs for 52204PPRRVU2026_Oct_nonQPP.csv, line 6,111 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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