Billing code 52301: Ureterocele treatmentMedicare rate & RVUs in Washington
A urologist uses cystoscopy to incise or resect a ureterocele, typically to open the obstructed ureteral outlet or relieve related urinary symptoms.
CMS doesn’t publish an office rate for 52301 in Washington.
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 52301 covers
A ureterocele is a ballooning of the ureter’s lower end where it enters the bladder. In an operating room or endoscopy suite, a urologist passes a cystoscope through the urethra and incises or resects the ureterocele to open the outlet. This is used for ureteroceles associated with impaired drainage, recurrent infection, or other urinary tract problems. The operative report should identify the ureterocele and describe the endoscopic treatment performed.
Report this code when the documented procedure meets its ureterocele-treatment criteria; distinguish it from a less extensive ureterocele incision code by the work recorded, not by diagnosis alone. The minor-procedure global period is zero days, with same-day preoperative and postoperative care included. When related endoscopies are performed together, endoscopy-family pricing applies. The code is priced as bilateral, so modifier 50 does not increase payment. Assistant-at-surgery payment requires documentation of 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 52301 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $254.91 |
| Seattle (King Cnty) | Unavailable | $272.11 |
How the 52301 rate is calculated
Each of 52301’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 · 52301
RVUs × geographic indexes × conversion factor
Work5.36
5.36 RVUs× 1.000 GPCI
Practice expense1.60
1.60 RVUs× 1.000 GPCI
Malpractice0.68
0.68 RVUs× 1.000 GPCI
Adjusted RVUs
7.6400
Conversion factor
$33.4009
Medicare rate
$255.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52301
The CMS indicators that decide how 52301 is paid alongside other services.
CMS payment indicators · 52301
Ureterocele treatment
| 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) | 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 51 · payment effect
With and without the modifier
52301 without 51 · national facility
$255.18
Ureterocele treatment
52301-51 · Second procedure: 50%
$127.59
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%).
52301 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 52300Ureterocele treatment
- This is the closely related ureterocele-treatment code. Select between the codes based on the specific procedure and extent documented in the operative report.
- 52305Cystourethroscopy
- This code describes fulguration at specified lower urinary tract sites. It is not the code for incising or resecting a ureterocele.
- 52310Cystoscopic removal
- This code concerns simple removal of a foreign body, calculus, or ureteral stent from the urethra or bladder, rather than ureterocele treatment.
52301 billing questions
How do I distinguish this from 52300?
Both address endoscopic ureterocele treatment. Use the code that matches the documented extent and nature of the work; the operative report should support any distinction in procedure complexity.
Can I append modifier 50 for treatment on both sides?
No. CMS prices this code as bilateral, and modifier 50 does not increase payment.
Is same-day postoperative care separately included?
The code has a zero-day global period, and same-day preoperative and postoperative care is included.
What happens when another related endoscopy is performed in the same session?
Endoscopy-family pricing applies when related endoscopies are performed together. The operative documentation should identify each distinct procedure performed.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. 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 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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