CPT code 52318: Bladder stone removal, large or complicated stone2026 Medicare rate & RVUs in California
Endoscopic fragmentation and evacuation of a large or complicated bladder stone, reported when treatment exceeds simple removal of a small calculus.
CMS doesn’t publish an office rate for 52318 in California.
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 52318 covers
During this urologic procedure, the physician passes a cystoscope through the urethra into the bladder, fragments a bladder calculus, and evacuates the pieces. It is used for a large stone (>2.5 cm) or when treatment is complicated. A urologist typically performs it in a hospital outpatient department or ambulatory surgery center, with selected cases in an office setting.
Choose this level from the operative report: document the bladder location, stone size when measured, method of fragmentation and removal, and what made treatment complicated when size alone does not support the level. The related simple or small-stone service is 52317. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies occur in the same session, endoscopy-family pricing applies. Modifier 50 is inappropriate; assistant-at-surgery payment is barred, 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 52318 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $412.04 |
| Chico, CA | Unavailable | $408.62 |
| El Centro, CA | Unavailable | $408.81 |
| Fresno, CA | Unavailable | $408.62 |
| Hanford, CA | Unavailable | $408.62 |
| Los Angeles, CA | Unavailable | $427.41 |
| Madera, CA | Unavailable | $408.62 |
| Marin County, CA | Unavailable | $452.97 |
| Merced, CA | Unavailable | $408.62 |
| Modesto, CA | Unavailable | $408.62 |
| Napa, CA | Unavailable | $438.26 |
| Oxnard, CA | Unavailable | $421.86 |
| Redding, CA | Unavailable | $408.62 |
| Rest of California | Unavailable | $408.62 |
| Riverside, CA | Unavailable | $421.20 |
| Sacramento, CA | Unavailable | $419.42 |
| Salinas, CA | Unavailable | $417.62 |
| San Benito County, CA | Unavailable | $462.88 |
| San Diego, CA | Unavailable | $420.39 |
| San Francisco, CA | Unavailable | $451.65 |
| San Luis Obispo, CA | Unavailable | $411.91 |
| Santa Clara County, CA | Unavailable | $457.50 |
| Santa Cruz, CA | Unavailable | $418.92 |
| Santa Maria, CA | Unavailable | $417.26 |
| Santa Rosa, CA | Unavailable | $422.60 |
| Stockton, CA | Unavailable | $408.62 |
| Vallejo, CA | Unavailable | $436.37 |
| Visalia, CA | Unavailable | $408.62 |
| Yuba City, CA | Unavailable | $408.62 |
How the 52318 rate is calculated
Each of 52318’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 · 52318
RVUs × geographic indexes × conversion factor
Work8.95
8.95 RVUs× 1.000 GPCI
Practice expense2.29
2.29 RVUs× 1.000 GPCI
Malpractice1.16
1.16 RVUs× 1.000 GPCI
Adjusted RVUs
12.4000
Conversion factor
$33.4009
Medicare rate
$414.17
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52318
The CMS indicators that decide how 52318 is paid alongside other services.
CMS payment indicators · 52318
Bladder stone removal, large or complicated stone
| 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
52318 without 51 · national facility
$414.17
Bladder stone removal, large or complicated stone
52318-51 · Second procedure: 50%
$207.09
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%).
52318 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52317Bladder stone removalSmall or simple calculus
- Use 52317 for simple treatment of a small bladder stone (<2.5 cm). Use 52318 for complicated treatment or a large stone (>2.5 cm).
- 52320Ureteral stone removalWithout stone fragmentation
- 52320 treats a ureteral calculus through cystoscopic access. For a calculus in the bladder treated by fragmentation and evacuation, consider 52318 when the treatment is complicated or the stone is large.
- 52352UreteroscopyStone removal or manipulation
- 52352 involves ureteroscopy or pyeloscopy to remove or manipulate a calculus in the upper urinary tract. 52318 is for a bladder calculus treated endoscopically.
52318 billing questions
How does 52318 differ from 52317?
52318 is for complicated treatment or a large bladder stone (>2.5 cm). 52317 is for simple treatment of a small stone (<2.5 cm).
Is stone size alone enough to support 52318?
A stone larger than 2.5 cm supports the large-stone level. For a smaller stone, the operative report should explain why treatment was complicated.
Can the cystoscopy be billed separately?
The cystoscopic access is part of the stone-treatment service; do not report a separate diagnostic cystoscopy for that same work.
Should modifier 50 be appended for multiple bladder stones?
No. CMS identifies bilateral adjustment as inapplicable for this service, and modifier 50 is inappropriate.
How is 52318 handled with another endoscopic procedure in the same session?
When related endoscopies are performed together, CMS applies endoscopy-family pricing. Same-day preoperative and postoperative care is included in the 0-day global period.
Can an assistant or co-surgeon be billed?
CMS does not pay an assistant at surgery for this service and does not permit co-surgeons or team surgery.
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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