CPT code 52305: Cystourethroscopy, congenital urethral obstruction2026 Medicare rate & RVUs in Missouri
Cystourethroscopic treatment of congenital posterior urethral valves or an obstructive posterior urethral membrane, typically performed to relieve urinary outflow obstruction.
CMS doesn’t publish an office rate for 52305 in Missouri.
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 52305 covers
A urologist treats congenital posterior urethral valves or an obstructive posterior urethral membrane by working through a cystoscope passed into the urethra. The endoscopic intervention opens or removes the obstructing tissue to improve urine flow. This procedure is most often encountered in pediatric urology, including treatment of a child with urinary outflow obstruction identified during evaluation of the lower urinary tract. The operative report should identify the congenital obstruction and describe the treatment performed.
Report this code for treatment of the congenital urethral obstruction, not for incision of a ureterocele or removal of a bladder or urethral foreign body. The note should support the specific diagnosis, endoscopic approach, and intervention. 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 for this descriptor or anatomy. CMS payment rules also restrict assistant-at-surgery payment and do not permit co-surgeons or team surgery.
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 52305 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $241.27 |
| Metropolitan St. Louis, MO | Unavailable | $242.47 |
| Rest of Missouri | Unavailable | $237.34 |
How the 52305 rate is calculated
Each of 52305’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 · 52305
RVUs × geographic indexes × conversion factor
Work5.17
5.17 RVUs× 1.000 GPCI
Practice expense1.50
1.50 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
7.3300
Conversion factor
$33.4009
Medicare rate
$244.83
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52305
The CMS indicators that decide how 52305 is paid alongside other services.
CMS payment indicators · 52305
Cystourethroscopy, congenital urethral obstruction
| 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
52305 without 51 · national facility
$244.83
Cystourethroscopy, congenital urethral obstruction
52305-51 · Second procedure: 50%
$122.42
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%).
52305 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 52300Ureterocele treatmentEndoscopic incision or resection
- This code treats congenital posterior urethral obstruction; 52300 is for cystoscopic incision of a ureterocele.
- 52301Ureterocele treatmentCystoscopic incision or resection
- This code addresses congenital posterior urethral valves or membrane; 52301 is associated with ureterocele treatment.
- 52310Cystoscopic removalSimple urethral or bladder removal
- Use 52310 for simple cystoscopic removal of a foreign body, calculus, or ureteral stent from the bladder or urethra, not congenital outlet obstruction.
- 52315Cystoscopic removalComplicated extraction
- 52315 covers complex cystoscopic removal of a foreign body, calculus, or ureteral stent; it is not treatment of congenital posterior urethral obstruction.
52305 billing questions
When is this code appropriate instead of 52300 or 52301?
Use this code for endoscopic treatment of congenital posterior urethral valves or an obstructive posterior urethral membrane. Codes 52300 and 52301 concern ureterocele treatment.
Can diagnostic cystoscopy be reported separately?
Cystoscopic access and visualization are part of the operative service. The documentation should describe the congenital obstruction and the treatment performed, rather than treating the diagnostic inspection as a separate service.
Does modifier 50 apply?
No. CMS identifies bilateral adjustment as inappropriate for this descriptor or anatomy.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's global period.
Can an assistant, co-surgeon, or surgical team be paid?
CMS lists a statutory restriction on assistant-at-surgery payment for this code and does not permit co-surgeons or team surgery.
What happens when another related endoscopy is performed during the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The operative documentation should support each service reported.
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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