Billing code 52204: Cystoscopic biopsyMedicare rate & RVUs in Illinois
A urologist uses cystoscopy to collect bladder tissue for pathology when a visible abnormality or selected area needs histologic evaluation.
Medicare pays $339.20–$371.98 for 52204 in the office in Illinois, from Rest Of Illinois to Chicago. 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 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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$339.20 to $371.98
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $371.98 | $142.38 |
| East St. Louis | $346.14 | $135.95 |
| Rest Of Illinois | $339.20 | $130.61 |
| Suburban Chicago | $371.75 | $137.12 |
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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