CPT code 52224: Bladder lesion treatment, lesions under 0.5 cm2026 Medicare rate & RVUs in Illinois
Reports cystoscopic destruction of small bladder lesions under 0.5 cm, including treatment with electrosurgery, cryosurgery, or laser.
Medicare pays $716.18–$790.28 for 52224 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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 52224 covers
A urologist uses a cystoscope to identify and destroy small bladder lesions measuring less than 0.5 cm. Treatment may use electrosurgical fulguration, cryosurgery, or laser. The procedure is performed in an office or facility setting, with the setting and anesthesia depending on the patient and clinical circumstances. It is used for small bladder lesions, including small papillary tumors.
Select this code when the treated bladder lesion or lesions meet the under-0.5-cm size criterion; document their location, size, number, and treatment method. A biopsy performed as part of treatment does not by itself change the lesion-size selection. 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. Modifier 50 is inappropriate. CMS does not pay for an assistant at surgery, and 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 52224 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.
4 payment localities
$716.18 to $790.28
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $785.38 | $197.94 |
| East St. Louis, IL | $727.85 | $190.09 |
| Rest of Illinois | $716.18 | $182.52 |
| Suburban Chicago, IL | $790.28 | $189.99 |
How the 52224 rate is calculated
Each of 52224’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 · 52224
RVUs × geographic indexes × conversion factor
Work3.95
3.95 RVUs× 1.000 GPCI
Practice expense18.32
18.32 RVUs× 1.000 GPCI
Malpractice0.49
0.49 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 52224
The CMS indicators that decide how 52224 is paid alongside other services.
CMS payment indicators · 52224
Bladder lesion treatment, lesions under 0.5 cm
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
52224 without 51 · national office
$760.20
Bladder lesion treatment, lesions under 0.5 cm
52224-51 · Second procedure: 50%
$380.10
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%).
52224 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52204Cystoscopic biopsyBladder tissue sampling
- 52204 is for cystoscopic bladder biopsy. Use 52224 when small bladder lesions are destroyed by fulguration, cryosurgery, or laser.
- 52214Cystoscopy treatmentFulguration at specified sites
- 52214 covers fulguration at specified sites such as the bladder neck, trigone, prostatic fossa, urethra, or periurethral glands. Code 52224 is for small bladder lesions under 0.5 cm.
- 52234Bladder tumor treatmentTumor 0.5 to 2.0 cm
- 52234 is for medium-size bladder lesions, while 52224 is limited to lesions under 0.5 cm.
52224 billing questions
When should this code be selected instead of 52234?
Use 52224 for bladder lesions under 0.5 cm. Code 52234 is for lesions in the medium-size category, beginning at 0.5 cm.
How does this differ from 52214?
52224 describes fulguration of small bladder lesions under 0.5 cm. Code 52214 addresses fulguration at specified sites such as the bladder neck, trigone, prostatic fossa, urethra, or periurethral glands.
Can a biopsy be reported separately when the lesion is fulgurated?
Do not report a separate biopsy code solely for biopsy performed as part of treating the lesion. Code 52204 is for cystoscopic biopsy when biopsy, rather than lesion fulguration, is the service performed.
What documentation supports the lesion-size code?
Document the bladder lesion location, measured size, number of lesions treated, and the method used to destroy them. The record should support that the treated lesion size is under 0.5 cm.
Can modifier 50 or an assistant-at-surgery modifier be used?
Modifier 50 is inappropriate for this code. CMS does not pay for an assistant at surgery; co-surgeons and team surgery are not permitted.
How are same-day related endoscopies handled?
CMS endoscopy-family pricing applies when related endoscopies are performed together. Same-day preoperative and postoperative care is included in this code's 0-day global period.
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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