No office rate
52351 covers ureteroscopic or pyeloscopic inspection without biopsy. When tissue is sampled from the ureter or renal pelvis, use 52354 for that service.
On this page
CMS RVU26D · Effective 2026-10-01
52354 Upper urinary tract biopsy Medicare reimbursement rates in Kentucky
Report this service when a urologist uses a ureteroscope or pyeloscope to obtain tissue from a suspected lesion in the ureter or renal pelvis. Compare 52354 office and facility rates across CMS payment localities in Kentucky.
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 52354 in Kentucky?
Kentucky 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
No supported rate
Facility setting
$355.54
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 endoscopy
About 52354: Ureteroscopic or pyeloscopic biopsy
Report this service when a urologist uses a ureteroscope or pyeloscope to obtain tissue from a suspected lesion in the ureter or renal pelvis.
A urologist advances an endoscope through the bladder into the ureter and, when needed, the renal pelvis, then obtains tissue from a suspicious area. Common situations include evaluating an upper-tract filling defect or suspected urothelial lesion identified on imaging or during endoscopy. The procedure is generally performed in an operating room or outpatient surgical setting; the specimen is submitted for pathologic examination.
Select this code when the documented service includes biopsy of the ureter and/or renal pelvis, rather than inspection alone, stone treatment, or tumor excision. The operative report should identify the side and site examined, the abnormality sampled, and that tissue was obtained. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, CMS endoscopy family pricing applies. For bilateral procedures reported with modifier 50, CMS pays at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 52354
- 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
- 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 RVU7.80 · 71%
- Practice expense (office) RVU2.15 · 20%
- Malpractice RVU1.02 · 9%
9.8K
Medicare services in 2024 · #1474 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.
52354 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
52355 is for endoscopic tumor excision; 52354 is for obtaining tissue by biopsy. Distinguish the documented extent and intent of the procedure.
No office rate
52352 describes endoscopic stone removal, not biopsy of a ureteral or renal-pelvis lesion.
No office rate
52353 describes endoscopic lithotripsy of a urinary stone. 52354 applies when the service includes biopsy of ureter or renal-pelvis tissue.
Compare 52354 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$355.54
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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 52354 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,153
- Code
- 52354
- Physician work
- 7.80
- Practice expense
- 2.15
- Malpractice
- 1.02
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.80 | × 1.000 | 7.8000 |
| Practice expense | 2.15 | × 0.889 | 1.9113 |
| Malpractice | 1.02 | × 0.915 | 0.9333 |
| Total RVUs | 10.6446 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$355.54
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.8 | 1 |
| Practice expense | 2.15 | 0.889 |
| Malpractice | 1.02 | 0.915 |
(7.8 × 1 + 2.15 × 0.889 + 1.02 × 0.915) × $33.4009 = $355.54
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.
52354 billing questions
When should 52354 be chosen over 52351?
Use 52354 when ureteroscopy or pyeloscopy includes obtaining a biopsy from the ureter or renal pelvis. Use 52351 for inspection without biopsy or another separately described intervention.
Can diagnostic ureteroscopy be billed separately with the biopsy?
Do not separately report the diagnostic inspection that is part of the same ureteroscopic service leading to biopsy. CMS endoscopy family pricing also applies when related endoscopies are performed together.
How does 52354 differ from 52355?
52354 describes sampling tissue for biopsy. 52355 is the related code for endoscopic excision of a tumor, not simply taking a biopsy specimen.
How is bilateral biopsy reported for Medicare?
For a bilateral procedure, report modifier 50; CMS pays the bilateral service at 150%.
What operative documentation supports 52354?
Document the ureteroscopic or pyeloscopic approach, the side and anatomic site, the lesion or abnormality sampled, and that tissue was obtained for biopsy.
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.
6,15052351,,Cystouretero & or pyeloscope,A,,5.61,1.66,NA,1.66,,0.71,7.98,7.98,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,15152352,,Cystouretero w/stone remove,A,,6.58,1.90,NA,1.90,,0.85,9.33,9.33,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15252353,,Cystouretero w/lithotripsy,A,,7.31,2.05,NA,2.05,,0.93,10.29,10.29,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15352354,,Cystouretero w/biopsy,A,,7.80,2.15,NA,2.15,,1.02,10.97,10.97,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15452355,,Cystouretero w/excise tumor,A,,8.78,2.36,NA,2.36,,1.13,12.27,12.27,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15552356,,Cysto/uretero w/lithotripsy,A,,7.80,2.11,NA,2.11,,1.02,10.93,10.93,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15652400,,Cysto cgen post urtl valves,A,,8.47,3.26,NA,3.26,,1.09,12.82,12.82,0,090,0.08,0.83,0.09,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631