Billing code 50972: UreteroscopyMedicare rate & RVUs in Texas
Reports endoscopic examination of the ureter through a ureterostomy when the urologist also inserts a ureteral catheter.
CMS doesn’t publish an office rate for 50972 in Texas.
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 50972 covers
The urologist passes an endoscope through an existing ureterostomy to examine the ureter and inserts a ureteral catheter. The service is used when access is through the stoma rather than the urethra, such as during evaluation or management of a patient with a surgically created ureterostomy. It is performed by a urologist in an operating room or another setting equipped for endoscopic urinary tract procedures.
Select this code when the documented procedure includes both ureteroscopy through the ureterostomy and catheter insertion; a diagnostic examination alone or an added biopsy or treatment belongs to a different code in the family. The operative report should identify the route, ureter examined, catheter placement, and any additional work. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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.
Where 50972 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $314.98 |
| Beaumont | Unavailable | $306.74 |
| Brazoria | Unavailable | $309.15 |
| Dallas | Unavailable | $311.95 |
| Fort Worth | Unavailable | $311.72 |
| Galveston | Unavailable | $310.67 |
| Houston | Unavailable | $326.59 |
| Rest Of Texas | Unavailable | $308.37 |
How the 50972 rate is calculated
Each of 50972’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 · 50972
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.71Practice expense 1.83Malpractice 0.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 50972
The CMS indicators that decide how 50972 is paid alongside other services.
CMS payment indicators · 50972
Ureteroscopy
| 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 | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| 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
50972 without 50 · national facility
$314.30
Ureteroscopy
50972-50 · Bilateral: 150%
$471.45
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).
50972 compared with similar codes
Compare codes
50972 vs 50970 vs 50974 vs 50976: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 50970Ureter endoscopy
- Choose 50970 for ureteroscopy through a ureterostomy without catheter insertion. Choose 50972 when a ureteral catheter is also inserted.
- 50974Ureteroscopy
- 50974 captures ureteroscopy through a ureterostomy with biopsy. 50972 represents catheter insertion without that biopsy service.
- 50976Ureteroscopy
- 50976 is for ureteroscopy through a ureterostomy with therapeutic work; 50972 describes catheter insertion as the additional service.
50972 billing questions
When should I choose 50972 instead of 50970?
Use 50972 when ureteroscopy through a ureterostomy includes insertion of a ureteral catheter. Use 50970 for the endoscopic service without catheter insertion.
Can a biopsy or ureteral treatment be included in 50972?
When the procedure includes biopsy or a separately defined therapeutic service, select the applicable code for that work rather than treating 50972 as a general ureteroscopy code. The operative report should make the work performed clear.
How is bilateral 50972 reported?
Report bilateral performance with modifier 50. CMS pays the bilateral procedure at 150%.
Does the 0-day global period include same-day care?
Yes. Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
Can an assistant surgeon be paid for 50972?
Assistant-at-surgery payment is available only when medical necessity is documented. 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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