CPT code 52354: Upper urinary tract biopsy, ureter or renal pelvis2026 Medicare rate & RVUs in Missouri
Report this service when a urologist uses a ureteroscope or pyeloscope to obtain tissue from a suspected lesion in the ureter or renal pelvis.
CMS doesn’t publish an office rate for 52354 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 52354 covers
A urologist advances an endoscope through the bladder into the ureter and, when needed, the renal pelvis, then obtains tissue from a suspicious area. Common situations include evaluating an upper-tract filling defect or suspected urothelial lesion identified on imaging or during endoscopy. The procedure is generally performed in an operating room or outpatient surgical setting; the specimen is submitted for pathologic examination.
Select this code when the documented service includes biopsy of the ureter and/or renal pelvis, rather than inspection alone, stone treatment, or tumor excision. The operative report should identify the side and site examined, the abnormality sampled, and that tissue was obtained. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. For bilateral procedures reported with modifier 50, CMS pays at 150%. Assistant-at-surgery payment is restricted; 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 52354 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 | $361.24 |
| Metropolitan St. Louis, MO | Unavailable | $363.03 |
| Rest of Missouri | Unavailable | $355.61 |
How the 52354 rate is calculated
Each of 52354’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 · 52354
RVUs × geographic indexes × conversion factor
Work7.80
7.80 RVUs× 1.000 GPCI
Practice expense2.15
2.15 RVUs× 1.000 GPCI
Malpractice1.02
1.02 RVUs× 1.000 GPCI
Adjusted RVUs
10.9700
Conversion factor
$33.4009
Medicare rate
$366.41
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52354
The CMS indicators that decide how 52354 is paid alongside other services.
CMS payment indicators · 52354
Upper urinary tract biopsy, ureter or renal pelvis
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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 50 · payment effect
With and without the modifier
52354 without 50 · national facility
$366.41
Upper urinary tract biopsy, ureter or renal pelvis
52354-50 · Bilateral: 150%
$549.62
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
52354 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 52351UreteroscopyDiagnostic examination only
- 52351 covers ureteroscopic or pyeloscopic inspection without biopsy. When tissue is sampled from the ureter or renal pelvis, use 52354 for that service.
- 52355Tumor resectionUreter or renal pelvis
- 52355 is for endoscopic tumor excision; 52354 is for obtaining tissue by biopsy. Distinguish the documented extent and intent of the procedure.
- 52352UreteroscopyStone removal or manipulation
- 52352 describes endoscopic stone removal, not biopsy of a ureteral or renal-pelvis lesion.
- 52353Stone lithotripsyUreteroscopy or pyeloscopy
- 52353 describes endoscopic lithotripsy of a urinary stone. 52354 applies when the service includes biopsy of ureter or renal-pelvis tissue.
52354 billing questions
When should 52354 be chosen over 52351?
Use 52354 when ureteroscopy or pyeloscopy includes obtaining a biopsy from the ureter or renal pelvis. Use 52351 for inspection without biopsy or another separately described intervention.
Can diagnostic ureteroscopy be billed separately with the biopsy?
Do not separately report the diagnostic inspection that is part of the same ureteroscopic service leading to biopsy. CMS endoscopy family pricing also applies when related endoscopies are performed together.
How does 52354 differ from 52355?
52354 describes sampling tissue for biopsy. 52355 is the related code for endoscopic excision of a tumor, not simply taking a biopsy specimen.
How is bilateral biopsy reported for Medicare?
For a bilateral procedure, report modifier 50; CMS pays the bilateral service at 150%.
What operative documentation supports 52354?
Document the ureteroscopic or pyeloscopic approach, the side and anatomic site, the lesion or abnormality sampled, and that tissue was obtained for biopsy.
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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