Billing code 52290: Ureterocele incisionMedicare rate & RVUs in Texas
A urologist incises a ureterocele through a cystoscope to open the obstructed ureteral outlet and improve urine drainage.
CMS doesn’t publish an office rate for 52290 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 52290 covers
A urologist uses a cystoscope passed through the urethra to reach the bladder and make an incision in a ureterocele at the ureteral opening. The opening allows urine to drain more freely when the ureterocele is obstructing urinary flow. The procedure is performed endoscopically in an operating room or another setting equipped for cystoscopy; ureteroceles may be treated in pediatric or adult patients.
Report the service when the operative record supports incision of a ureterocele, rather than biopsy, ureteral-orifice meatotomy, or resection. Document the ureterocele, its location and side, the incision performed, and the clinical indication. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. The code is priced as bilateral; modifier 50 does not increase payment. When related endoscopies are performed together, endoscopy-family pricing applies. Assistant-at-surgery payment is statutorily restricted; 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 52290 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 | $216.30 |
| Beaumont | Unavailable | $209.85 |
| Brazoria | Unavailable | $212.02 |
| Dallas | Unavailable | $213.89 |
| Fort Worth | Unavailable | $213.66 |
| Galveston | Unavailable | $213.03 |
| Houston | Unavailable | $223.46 |
| Rest Of Texas | Unavailable | $211.19 |
How the 52290 rate is calculated
Each of 52290’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 · 52290
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.47Practice expense 1.41Malpractice 0.57
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 52290
The CMS indicators that decide how 52290 is paid alongside other services.
CMS payment indicators · 52290
Ureterocele incision
| 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) | 2 | Already bilateral by definition: paid once at 100%. |
| 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
52290 without 51 · national facility
$215.44
Ureterocele incision
52290-51 · Second procedure: 50%
$107.72
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%).
52290 compared with similar codes
Compare codes
52290 vs 52301 vs 52300 vs 52204: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 52301Ureterocele treatment
- 52290 is used for incision of a ureterocele; 52301 is used when the ureterocele is resected.
- 52300Ureterocele treatment
- 52300 describes ureteral meatotomy. It is not the code for incising a ureterocele.
- 52204Cystoscopic biopsy
- 52204 is for cystoscopic bladder biopsy. It does not represent therapeutic incision of a ureterocele.
52290 billing questions
When should 52290 be selected instead of 52301?
Use 52290 for endoscopic incision of a ureterocele. Code 52301 describes resection of a ureterocele, so select based on the procedure documented.
Is modifier 50 appropriate for bilateral treatment?
CMS prices 52290 as bilateral. Modifier 50 does not increase payment.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How are related endoscopies priced when performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is statutorily restricted for this code. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 52290?
Document the ureterocele and its location and side, the incision performed, and the reason for treatment, such as impaired urinary drainage.
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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