$367.67
50951 represents diagnostic ureteroscopy. Choose 50955 when the documented ureteroscopic service also includes biopsy.
On this page
CMS RVU26D · Effective 2026-10-01
50955 Ureteroscopy Medicare reimbursement rates in Indiana
Reports endoscopic examination of the ureter with tissue sampling, such as biopsy of a suspicious ureteral lesion during a facility-based procedure. Compare 50955 office and facility rates across CMS payment localities in Indiana.
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 50955 in Indiana?
Indiana 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
$415.30
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$290.52
1 of 1 localities have a supported rate.
Payment area: Indiana
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
About 50955: Ureteroscopy with biopsy
Reports endoscopic examination of the ureter with tissue sampling, such as biopsy of a suspicious ureteral lesion during a facility-based procedure.
A urologist passes an endoscope into the ureter to inspect its lining and obtain tissue from a finding that needs pathologic evaluation. A typical clinical situation is sampling a suspicious upper-tract urothelial lesion. The service is commonly performed in a hospital or ambulatory surgery setting; Medicare recorded facility services for this code in 2024.
Report the code when the documented ureteroscopic service includes biopsy, and support it with the indication, ureter and side examined, endoscopic findings, and tissue-sampling details. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral procedures, modifier 50 is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 50955
- 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 procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.57 · 49%
- Practice expense (office) RVU5.88 · 44%
- Malpractice RVU0.85 · 6%
30
Medicare services in 2024 · #5674 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.
50955 compared with similar codes
Office rates for Indiana, from the same CMS release.
$419.12
50957 is a ureteroscopic treatment code. This code is for ureteroscopy with biopsy rather than treatment-focused work.
No office rate
Both short descriptors identify ureteroscopic biopsy. Compare the full CPT descriptors and operative documentation to determine which service configuration was performed.
Compare 50955 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
Indiana →
Office / nonfacility
$415.30
Facility
$290.52
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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 50955 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
6,007
- Code
- 50955
- Physician work
- 6.57
- Practice expense
- 5.88
- Malpractice
- 0.85
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.57 | × 1.000 | 6.5700 |
| Practice expense | 5.88 | × 0.927 | 5.4508 |
| Malpractice | 0.85 | × 0.486 | 0.4131 |
| Total RVUs | 12.4339 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$415.30
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.57 | 1 |
| Practice expense | 5.88 | 0.927 |
| Malpractice | 0.85 | 0.486 |
(6.57 × 1 + 5.88 × 0.927 + 0.85 × 0.486) × $33.4009 = $415.30
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.57 | 1 |
| Practice expense | 1.85 | 0.927 |
| Malpractice | 0.85 | 0.486 |
(6.57 × 1 + 1.85 × 0.927 + 0.85 × 0.486) × $33.4009 = $290.52
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.
50955 billing questions
When should this code be selected instead of diagnostic ureteroscopy?
Use this code when the ureteroscopic service includes biopsy. A diagnostic-only examination without tissue sampling is represented by a diagnostic ureteroscopy code, such as 50951.
Can the biopsy be reported separately from the ureteroscopy?
This code describes ureteroscopy with biopsy. The record should show the endoscopic examination and tissue sampling; do not treat the biopsy as an unrelated service merely because a specimen is sent to pathology.
How does CMS handle related endoscopies performed together?
Endoscopy family pricing applies when related endoscopies are performed together. The code’s payment is subject to that family pricing in the combined service.
How is a bilateral procedure reported?
For a bilateral procedure, report modifier 50; CMS pays the procedure at 150%. Document the ureteral work on both sides.
What assistant or co-surgeon rules apply?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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.
6,00450949,,Unlisted laps px ureter,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,1,2,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
6,00550951,,Endoscopy of ureter,A,,5.68,5.37,,1.66,,0.72,11.77,8.06,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,00650953,,Endoscopy of ureter,A,,6.07,5.63,,1.75,,0.79,12.49,8.61,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50951,33.4009,09,0,99,0.00,0.00,0.00
6,00750955,,Ureter endoscopy & biopsy,A,,6.57,5.88,,1.85,,0.85,13.30,9.27,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50951,33.4009,09,0,99,0.00,0.00,0.00
6,00850957,,Ureter endoscopy & treatment,A,,6.61,5.96,,1.86,,0.85,13.42,9.32,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50951,33.4009,09,0,99,0.00,0.00,0.00
6,00950961,,Ureter endoscopy & treatment,A,,5.89,5.48,,1.71,,0.76,12.13,8.36,0,000,0.00,0.00,0.00,3,1,0,0,0,9,50951,33.4009,09,0,99,0.00,0.00,0.00
6,01050970,,Ureter endoscopy,A,,6.95,1.88,NA,1.88,,0.90,9.73,9.73,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915