Billing code 52204: Cystoscopic biopsyMedicare rate & RVUs
A urologist uses cystoscopy to collect bladder tissue for pathology when a visible abnormality or selected area needs histologic evaluation.
Medicare pays $355.39 for 52204 nationally in the office and $126.92 in a hospital or facility. Local office rates run $313.28–$474.12.
Medicare rate · 52204
Cystoscopic biopsy
Swap in your local Medicare rate.
- Work RVUs
- 2.53
- Total RVUs
- 10.64
- Global days
- 000
National rate · 2026
$355.39
Office setting, before claim adjustments.
See every locality for 52204 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
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.
Where 52204 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$313.28 to $474.12
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $318.02 | $118.11 |
| Alaska* | $409.41 | $166.10 |
| Arizona | $345.70 | $124.33 |
| Arkansas | $313.28 | $117.04 |
| Atlanta | $362.07 | $129.96 |
| Austin | $369.31 | $127.60 |
| Bakersfield | $377.47 | $127.07 |
| Baltimore/Surr. Cntys | $378.37 | $133.23 |
| Beaumont | $331.22 | $123.32 |
| Brazoria | $351.23 | $124.82 |
| Chicago | $371.98 | $142.38 |
| Chico | $376.47 | $126.07 |
| Colorado | $370.52 | $127.44 |
| Connecticut | $379.44 | $133.39 |
| Dallas | $353.50 | $125.95 |
| Dc + Md/Va Suburbs | $407.43 | $138.30 |
| Delaware | $351.55 | $125.83 |
| Detroit | $354.09 | $133.63 |
| East St. Louis | $346.14 | $135.95 |
| El Centro | $376.52 | $126.13 |
| Fort Lauderdale | $367.94 | $136.50 |
| Fort Worth | $351.05 | $125.78 |
| Fresno | $376.47 | $126.07 |
| Galveston | $352.29 | $125.43 |
| Hanford-Corcoran | $376.47 | $126.07 |
| Hawaii, Guam | $386.16 | $126.40 |
| Houston | $358.51 | $131.65 |
| Idaho | $328.64 | $118.45 |
| Indiana | $330.60 | $118.82 |
| Iowa | $326.48 | $117.44 |
| Kansas | $324.84 | $118.31 |
| Kentucky | $325.61 | $122.51 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $402.53 | $132.26 |
| Madera | $376.47 | $126.07 |
| Manhattan | $409.49 | $144.02 |
| Merced | $376.47 | $126.07 |
| Metropolitan Boston | $407.95 | $135.17 |
| Metropolitan Kansas City | $339.29 | $124.77 |
| Metropolitan Philadelphia | $369.74 | $131.91 |
| Metropolitan St. Louis | $342.95 | $125.46 |
| Miami | $383.39 | $145.56 |
| Minnesota | $354.92 | $119.83 |
| Mississippi | $316.35 | $119.64 |
| Modesto | $376.47 | $126.07 |
| Montana** | $355.36 | $126.90 |
| Napa | $437.65 | $136.54 |
| Nebraska | $328.34 | $117.47 |
| Nevada** | $353.75 | $125.06 |
| New Hampshire | $364.61 | $126.78 |
| New Mexico | $336.13 | $126.63 |
| New Orleans | $341.62 | $126.64 |
| North Carolina | $333.90 | $120.74 |
| North Dakota** | $348.64 | $120.18 |
| Northern Nj | $403.01 | $137.99 |
| Nyc Suburbs/Long Island | $419.58 | $147.93 |
| Ohio | $332.90 | $124.31 |
| Oklahoma | $325.08 | $121.07 |
| Oxnard-Thousand Oaks-Ventura | $400.70 | $130.66 |
| Portland | $382.64 | $128.82 |
| Poughkpsie/N Nyc Suburbs | $386.23 | $136.06 |
| Puerto Rico | $358.07 | $127.09 |
| Queens | $413.05 | $143.00 |
| Redding | $376.47 | $126.07 |
| Rest Of California | $376.47 | $126.07 |
| Rest Of Florida | $349.68 | $131.27 |
| Rest Of Georgia | $329.54 | $125.75 |
| Rest Of Illinois | $339.20 | $130.61 |
| Rest Of Louisiana | $325.06 | $122.87 |
| Rest Of Maine | $330.33 | $120.15 |
| Rest Of Maryland | $358.41 | $127.21 |
| Rest Of Massachusetts | $368.19 | $127.62 |
| Rest Of Michigan | $334.27 | $125.69 |
| Rest Of Missouri | $319.28 | $122.34 |
| Rest Of New Jersey | $383.74 | $134.26 |
| Rest Of New York | $339.04 | $122.00 |
| Rest Of Oregon | $350.97 | $123.43 |
| Rest Of Pennsylvania | $333.48 | $123.75 |
| Rest Of Texas | $341.05 | $124.24 |
| Rest Of Washington | $367.52 | $126.95 |
| Rhode Island | $364.33 | $128.33 |
| Riverside-San Bernardino-Ontario | $380.15 | $129.76 |
| Sacramento-Roseville-Folsom | $395.46 | $129.76 |
| Salinas | $394.00 | $129.21 |
| San Diego-Chula Vista-Carlsbad | $403.59 | $130.35 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $463.67 | $141.54 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $463.29 | $141.16 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $474.12 | $144.68 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $472.54 | $143.10 |
| San Luis Obispo-Paso Robles | $387.63 | $127.41 |
| Santa Cruz-Watsonville | $407.69 | $130.11 |
| Santa Maria-Santa Barbara | $395.56 | $129.18 |
| Santa Rosa-Petaluma | $411.82 | $131.27 |
| Seattle (King Cnty) | $416.44 | $136.12 |
| South Carolina | $333.96 | $122.86 |
| South Dakota** | $347.84 | $119.38 |
| Southern Maine | $348.86 | $122.45 |
| Stockton | $376.47 | $126.07 |
| Suburban Chicago | $371.75 | $137.12 |
| Tennessee | $326.51 | $118.84 |
| Utah | $338.66 | $123.90 |
| Vallejo | $437.09 | $135.98 |
| Vermont | $347.18 | $121.00 |
| Virgin Islands | $358.07 | $127.09 |
| Virginia | $347.63 | $123.06 |
| Visalia | $376.47 | $126.07 |
| West Virginia | $326.28 | $127.75 |
| Wisconsin | $336.63 | $117.76 |
| Wyoming** | $352.43 | $123.97 |
| Yuba City | $376.47 | $126.07 |
52204 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $409.41 | 1 |
| AL | $318.02 | 1 |
| AR | $313.28 | 1 |
| AZ | $345.70 | 1 |
| CA | $376.47–$474.12 | 29 |
| CO | $370.52 | 1 |
| CT | $379.44 | 1 |
| DC | $407.43 | 1 |
| DE | $351.55 | 1 |
| FL | $349.68–$383.39 | 3 |
| GA | $329.54–$362.07 | 2 |
| GU | $386.16 | 1 |
| HI | $386.16 | 1 |
| IA | $326.48 | 1 |
| ID | $328.64 | 1 |
| IL | $339.20–$371.98 | 4 |
| IN | $330.60 | 1 |
| KS | $324.84 | 1 |
| KY | $325.61 | 1 |
| LA | $325.06–$341.62 | 2 |
| MA | $368.19–$407.95 | 2 |
| MD | $358.41–$407.43 | 3 |
| ME | $330.33–$348.86 | 2 |
| MI | $334.27–$354.09 | 2 |
| MN | $354.92 | 1 |
| MO | $319.28–$342.95 | 3 |
| MS | $316.35 | 1 |
| MT | $355.36 | 1 |
| NC | $333.90 | 1 |
| ND | $348.64 | 1 |
| NE | $328.34 | 1 |
| NH | $364.61 | 1 |
| NJ | $383.74–$403.01 | 2 |
| NM | $336.13 | 1 |
| NV | $353.75 | 1 |
| NY | $339.04–$419.58 | 5 |
| OH | $332.90 | 1 |
| OK | $325.08 | 1 |
| OR | $350.97–$382.64 | 2 |
| PA | $333.48–$369.74 | 2 |
| PR | $358.07 | 1 |
| RI | $364.33 | 1 |
| SC | $333.96 | 1 |
| SD | $347.84 | 1 |
| TN | $326.51 | 1 |
| TX | $331.22–$369.31 | 8 |
| UT | $338.66 | 1 |
| VA | $347.63–$407.43 | 2 |
| VI | $358.07 | 1 |
| VT | $347.18 | 1 |
| WA | $367.52–$416.44 | 2 |
| WI | $336.63 | 1 |
| WV | $326.28 | 1 |
| WY | $352.43 | 1 |
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
Swap in your local Medicare rate.
Work 2.53Practice expense 7.77Malpractice 0.34
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 52204
The CMS indicators that decide how 52204 is paid alongside other services.
CMS payment indicators · 52204
Cystoscopic biopsy
| 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
52204 without 51 · national office
$355.39
Cystoscopic biopsy
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%).
52204 compared with similar codes
Compare codes
52204 vs 52000 vs 52214 vs 52224: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 52000Cystoscopy
- 52000 describes cystoscopic inspection without biopsy. Use 52204 when tissue is collected during cystoscopy.
- 52214Cystoscopy treatment
- 52214 describes cystoscopic treatment at specified lower urinary tract sites; 52204 is for collecting tissue for examination.
- 52224Bladder lesion treatment
- 52224 describes cystoscopic treatment of bladder lesions, while 52204 describes biopsy for histologic evaluation.
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
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