No office rate
This is the closely related ureterocele-treatment code. Select between the codes based on the specific procedure and extent documented in the operative report.
On this page
CMS RVU26D · Effective 2026-10-01
52301 Ureterocele treatment Medicare reimbursement rates in Wisconsin
A urologist uses cystoscopy to incise or resect a ureterocele, typically to open the obstructed ureteral outlet or relieve related urinary symptoms. Compare 52301 office and facility rates across CMS payment localities in Wisconsin.
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 52301 in Wisconsin?
Wisconsin 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
$237.22
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 procedure
About 52301: Cystoscopic ureterocele incision or resection
A urologist uses cystoscopy to incise or resect a ureterocele, typically to open the obstructed ureteral outlet or relieve related urinary symptoms.
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.
CMS billing rules for 52301
- 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.36 · 70%
- Practice expense (office) RVU1.60 · 21%
- Malpractice RVU0.68 · 9%
14
Medicare services in 2024 · #6108 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.
52301 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
This code describes fulguration at specified lower urinary tract sites. It is not the code for incising or resecting a ureterocele.
$282.09
This code concerns simple removal of a foreign body, calculus, or ureteral stent from the urethra or bladder, rather than ureterocele treatment.
Compare 52301 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$237.22
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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 52301 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
6,132
- Code
- 52301
- Physician work
- 5.36
- Practice expense
- 1.60
- Malpractice
- 0.68
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.36 | × 1.000 | 5.3600 |
| Practice expense | 1.60 | × 0.958 | 1.5328 |
| Malpractice | 0.68 | × 0.308 | 0.2094 |
| Total RVUs | 7.1022 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$237.22
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.36 | 1 |
| Practice expense | 1.6 | 0.958 |
| Malpractice | 0.68 | 0.308 |
(5.36 × 1 + 1.6 × 0.958 + 0.68 × 0.308) × $33.4009 = $237.22
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.
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 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.
6,12952287,,Cystoscopy chemodenervation,A,,3.12,7.34,,0.91,,0.43,10.89,4.46,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13052290,,Cystoscopy and treatment,A,,4.47,1.41,NA,1.41,,0.57,6.45,6.45,0,000,0.00,0.00,0.00,3,2,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13152300,,Cystoscopy and treatment,A,,5.17,1.57,NA,1.57,,0.66,7.40,7.40,0,000,0.00,0.00,0.00,3,2,0,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13252301,,Cystoscopy and treatment,A,,5.36,1.60,NA,1.60,,0.68,7.64,7.64,0,000,0.00,0.00,0.00,3,2,0,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13352305,,Cystoscopy and treatment,A,,5.17,1.50,NA,1.50,,0.66,7.33,7.33,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13452310,,Cystoscopy and treatment,A,,2.74,5.84,,0.93,,0.36,8.94,4.03,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,13552315,,Cystoscopy and treatment,A,,5.07,7.96,,1.52,,0.67,13.70,7.26,0,000,0.00,0.00,0.00,3,0,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,