Billing code 52007: Ureteral biopsyMedicare rate & RVUs in Delaware
Cystoscopic ureteral catheterization with brush sampling of a ureter or renal pelvis, typically used to evaluate a suspected upper urinary tract lesion.
Medicare pays $426.84 for 52007 in the office in Delaware (Delaware). Which amount applies depends on the service address.
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 9 sections
What 52007 covers
A urologist passes a cystoscope through the urethra into the bladder, advances a catheter into a ureter, and obtains a brush sample from the ureter or renal pelvis. The service is used when evaluation of a suspected upper-tract urothelial abnormality calls for brush sampling rather than tissue biopsy under direct ureteroscopic vision. It is typically performed in an operating room or procedure suite, with the specimen sent for pathologic evaluation.
Report the service for the catheter-directed brush biopsy, documenting the sampled site, laterality, clinical reason, and procedure performed. Routine cystoscopic access and ureteral catheterization for the brush sampling are included; do not separately report those steps for the same service. 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. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery services are subject to a statutory payment restriction; 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.
52007 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $426.84 | $146.67 |
How the 52007 rate is calculated
Each of 52007’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 · 52007
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.94Practice expense 9.58Malpractice 0.40
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 52007
The CMS indicators that decide how 52007 is paid alongside other services.
CMS payment indicators · 52007
Ureteral 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) | 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
52007 without 50 · national office
$431.54
Ureteral biopsy
52007-50 · Bilateral: 150%
$647.31
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).
52007 compared with similar codes
Compare codes
52007 vs 52005 vs 52354 vs 52351 vs 52000: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 52005Ureteral catheterization
- Choose 52005 for ureteral catheterization without brush biopsy. Use 52007 when the catheter is used to obtain a brush sample from the ureter or renal pelvis.
- 52354Upper urinary tract biopsy
- Use 52354 when biopsy is performed during ureteroscopy or pyeloscopy. Code 52007 describes brush sampling through a ureteral catheter.
- 52351Ureteroscopy
- Code 52351 represents diagnostic ureteroscopy or pyeloscopy. It does not describe the catheter-directed brush biopsy captured by 52007.
- 52000Cystoscopy
- Code 52000 is for cystoscopic inspection alone. It does not include the ureteral catheter brush sampling represented by 52007.
52007 billing questions
When should 52007 be chosen instead of 52005?
Use 52007 when a brush biopsy is taken from the ureter or renal pelvis through a ureteral catheter. Code 52005 describes ureteral catheterization without that brush-biopsy service.
Can cystoscopy or ureteral catheterization be billed separately?
Routine cystoscopic access and catheterization used to obtain the brush sample are included in 52007. Do not separately report 52000 or 52005 for those same steps.
How is a bilateral brush biopsy reported?
CMS identifies 52007 as a bilateral procedure; modifier 50 is paid at 150%. Document which ureters or renal pelvis sites were sampled.
How does 52007 differ from 52354?
52007 involves brush sampling through a ureteral catheter. Code 52354 is used for biopsy performed during ureteroscopy or pyeloscopy, rather than catheter-directed brush sampling.
Are same-day related endoscopies paid independently?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The service also has a 0-day global period, which includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this service under the stated statutory restriction. 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
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