$199.50
52000 describes cystoscopic inspection without biopsy. Use 52204 when tissue is collected during cystoscopy.
On this page
CMS RVU26D · Effective 2026-10-01
52204 Cystoscopic biopsy Medicare reimbursement rates in Idaho
A urologist uses cystoscopy to collect bladder tissue for pathology when a visible abnormality or selected area needs histologic evaluation. Compare 52204 office and facility rates across CMS payment localities in Idaho.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 52204 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$328.64
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$118.45
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urology procedure
About 52204: Cystoscopic bladder biopsy
A urologist uses cystoscopy to collect bladder tissue for pathology when a visible abnormality or selected area needs histologic evaluation.
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.
CMS billing rules for 52204
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.53 · 24%
- Practice expense (office) RVU7.77 · 73%
- Malpractice RVU0.34 · 3%
26.1K
Medicare services in 2024 · #1032 by national volume
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.
52204 compared with similar codes
Office rates for Idaho, from the same CMS release.
$671.97
52214 describes cystoscopic treatment at specified lower urinary tract sites; 52204 is for collecting tissue for examination.
$702.63
52224 describes cystoscopic treatment of bladder lesions, while 52204 describes biopsy for histologic evaluation.
Compare 52204 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
$328.64
Facility
$118.45
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 52204 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
6,111
- Code
- 52204
- Physician work
- 2.53
- Practice expense
- 7.77
- Malpractice
- 0.34
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.53 | × 1.000 | 2.5300 |
| Practice expense | 7.77 | × 0.920 | 7.1484 |
| Malpractice | 0.34 | × 0.473 | 0.1608 |
| Total RVUs | 9.8392 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$328.64
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.53 | 1 |
| Practice expense | 7.77 | 0.92 |
| Malpractice | 0.34 | 0.473 |
(2.53 × 1 + 7.77 × 0.92 + 0.34 × 0.473) × $33.4009 = $328.64
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.53 | 1 |
| Practice expense | 0.93 | 0.92 |
| Malpractice | 0.34 | 0.473 |
(2.53 × 1 + 0.93 × 0.92 + 0.34 × 0.473) × $33.4009 = $118.45
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,10852007,,Cysto urtrl cathj brush bx,A,,2.94,9.58,,1.09,,0.40,12.92,4.43,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,1095200F,,Eval appros surg thxpy epi,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
6,11052010,,Cystoscopy & duct catheter,A,,2.94,7.61,,1.09,,0.38,10.93,4.41,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,11152204,,Cystoscopy w/biopsy(s),A,,2.53,7.77,,0.93,,0.34,10.64,3.80,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,11252214,,Cystoscopy and treatment,A,,3.41,17.94,,0.71,,0.43,21.78,4.55,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,11352224,,Cystoscopy and treatment,A,,3.95,18.32,,0.82,,0.49,22.76,5.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,11452234,,Cystoscopy and treatment,A,,4.50,1.42,NA,1.42,,0.57,6.49,6.49,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772