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Billing code 52345: UPJ stricture incisionMedicare rate & RVUs

Reports ureteroscopic or pyeloscopic incision of a narrowed ureteropelvic junction to open the passage between the renal pelvis and ureter.

CMS RVU26DEffective Oct 1, 2026109 payment localities383 Medicare services in 2024

Medicare pays $346.37 for 52345 nationally in a facility.

Medicare rate · 52345

UPJ stricture incision

Work RVUs
7.36
Total RVUs
10.37
Global days
000

National rate · 2026

$346.37

Facility setting, before claim adjustments.

See every locality for 52345 →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
  1. Medicare rate
  2. What 52345 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 52345 covers

A urologist uses cystoscopy with ureteroscopy and/or pyeloscopy to reach a narrowed ureteropelvic junction and make an endoscopic incision to relieve the obstruction. This procedure, often described clinically as endopyelotomy, is performed in an operating room, generally for a UPJ narrowing that impedes urine drainage from the kidney into the ureter. The code is specific to the ureteropelvic junction, not a stricture farther down the ureter or within the renal pelvis.

Report the code when the operative record identifies the UPJ stricture and documents its endoscopic incision. Distinguish it from treatment of a UPJ stricture without incision and from incision at another urinary-tract site. 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. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeon and team-surgery payment 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 52345 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

52345 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$324.00
Alaska*Unavailable$459.51
ArizonaUnavailable$339.67
ArkansasUnavailable$321.28
AtlantaUnavailable$354.58
AustinUnavailable$347.23
BakersfieldUnavailable$345.24
Baltimore/Surr. CntysUnavailable$362.84
BeaumontUnavailable$337.92
BrazoriaUnavailable$340.73

52345 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
52345 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 52345 rate is calculated

Each of 52345’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 · 52345

RVUs × geographic indexes × conversion factor

Work7.36

7.36 RVUs× 1.000 GPCI

Practice expense2.06

2.06 RVUs× 1.000 GPCI

Malpractice0.95

0.95 RVUs× 1.000 GPCI

Adjusted RVUs

10.3700

Conversion factor

$33.4009

Medicare rate

$346.37

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 52345

The CMS indicators that decide how 52345 is paid alongside other services.

CMS payment indicators · 52345

UPJ stricture incision

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

52345 without 50 · national facility

$346.37

UPJ stricture incision

52345-50 · Bilateral: 150%

$519.56

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).

When to use modifier 50

52345 compared with similar codes

Compare codes · National

4 codes, side by side

  • 52345

    UPJ stricture incision7.36 wRVU

    Not priced

  • 52342

    UPJ stricture treatment5.7 wRVU

    Not priced

  • 52344

    Stricture treatment6.87 wRVU

    Not priced

  • 52346

    Renal stricture treatment8.37 wRVU

    Not priced

How to choose

52342UPJ stricture treatment
Choose 52345 when the operative service incises a UPJ stricture. Code 52342 covers UPJ stricture treatment without specifying incision.
52344Stricture treatment
Both involve endoscopic incision, but 52344 is for a ureteral stricture and 52345 is for one at the ureteropelvic junction.
52346Renal stricture treatment
Both specify incision, but 52346 is for a renal pelvis stricture; 52345 identifies the ureteropelvic junction.

Codes related to 52345

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 52345
CodeHow it relatesNational office range
Same family
52342UPJ stricture treatmentUPJ stricture treatment without the incision specified for this code.No office rate
52344Stricture treatmentIncision of a ureteral stricture at a site below the UPJ.No office rate
52346Renal stricture treatmentIncision of a stricture in the renal pelvis rather than at the UPJ.No office rate
52341Ureteral stricture treatmentTreatment of a ureteral stricture, rather than incision of a UPJ stricture.No office rate
52343Renal stricture treatmentTreatment of a renal pelvis stricture at a different site.No office rate

52345 billing questions

How is this code different from 52342?

This code is for an incision of a ureteropelvic junction stricture. Code 52342 describes treatment of a UPJ stricture without specifying incision.

Can this code be used for a ureteral stricture below the UPJ?

No. It identifies incision at the ureteropelvic junction. An incision of a ureteral stricture is represented by 52344.

What operative details support reporting this code?

Document the stricture's location at the UPJ and that the surgeon incised it using cystoscopic access with ureteroscopy and/or pyeloscopy.

How should bilateral UPJ incisions be reported?

Use modifier 50 for a bilateral procedure. CMS pays the bilateral procedure at 150%.

Is same-day postoperative care included?

Yes. The 0-day global period includes same-day preoperative and postoperative care.

How are related endoscopies handled when performed in the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together; payment follows that pricing method rather than treating each as an unrelated endoscopy.

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
RVUs for 52345PPRRVU2026_Oct_nonQPP.csv, line 6,148 (RVU26D)

Open CMS sourceHow we calculate rates

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