Billing code 52351: UreteroscopyMedicare rate & RVUs in Washington
Reports endoscopic diagnostic inspection of the ureter or kidney collecting system when the upper urinary tract is examined without therapeutic treatment.
CMS doesn’t publish an office rate for 52351 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 52351 covers
A urologist advances an endoscope through the bladder into the ureter and, when needed, the kidney’s collecting system to inspect the upper urinary tract. The examination may be part of evaluating hematuria, an imaging abnormality, suspected obstruction, or a possible upper-tract lesion. It is performed in an office or procedural setting appropriate to the patient and planned examination.
Report 52351 when the ureter or collecting system is examined for diagnostic purposes and no separately coded therapeutic intervention defines the service. The operative note should identify the indication, side and anatomic area examined, scope findings, and any treatment performed. Medicare assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and 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 52351 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | Unavailable | $266.25 |
| Seattle (King Cnty) | Unavailable | $284.15 |
How the 52351 rate is calculated
Each of 52351’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 · 52351
RVUs × geographic indexes × conversion factor
Work5.61
5.61 RVUs× 1.000 GPCI
Practice expense1.66
1.66 RVUs× 1.000 GPCI
Malpractice0.71
0.71 RVUs× 1.000 GPCI
Adjusted RVUs
7.9800
Conversion factor
$33.4009
Medicare rate
$266.54
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 52351
The CMS indicators that decide how 52351 is paid alongside other services.
CMS payment indicators · 52351
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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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
52351 without 51 · national facility
$266.54
Ureteroscopy
52351-51 · Second procedure: 50%
$133.27
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%).
52351 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 52000Cystoscopy
- Choose 52000 for bladder cystoscopy alone. Choose 52351 when the diagnostic endoscopic examination extends into the ureter or kidney collecting system.
- 52352Ureteroscopy
- 52351 is for diagnostic inspection; 52352 describes ureteroscopic stone removal.
- 52353Stone lithotripsy
- 52351 describes diagnostic inspection, while 52353 is used when ureteroscopic lithotripsy treats a stone.
- 52354Upper urinary tract biopsy
- Use 52354 when the ureteroscopic service includes biopsy; 52351 is for diagnostic inspection without biopsy.
52351 billing questions
When should 52351 be used instead of a therapeutic ureteroscopy code?
Use 52351 for diagnostic inspection without a therapeutic intervention. If the session includes stone treatment, biopsy, or tumor excision, select the code describing that intervention rather than reporting diagnostic inspection as a separate service.
How does 52351 differ from 52000?
Code 52000 describes cystoscopy of the bladder. Code 52351 applies when the endoscopic examination extends into the ureter or kidney collecting system.
Can 52351 be reported with a stone-treatment code?
When ureteroscopy is performed to treat a stone, report the applicable therapeutic code, such as 52352 for stone removal or 52353 for lithotripsy. Diagnostic inspection that is part of that treatment is not separately reported.
Can modifier 50 be used for bilateral 52351?
No. CMS identifies bilateral adjustment as inapplicable and modifier 50 as inappropriate for this code.
How does Medicare handle other procedures performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50% when performed in the same session.
Are assistant or co-surgeon services payable with 52351?
Medicare does not pay an assistant at surgery for this code. 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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