No office rate
Choose 52345 when the operative service incises a UPJ stricture. Code 52342 covers UPJ stricture treatment without specifying incision.
On this page
CMS RVU26D · Effective 2026-10-01
52345 UPJ stricture incision Medicare reimbursement rates in Wisconsin
Reports ureteroscopic or pyeloscopic incision of a narrowed ureteropelvic junction to open the passage between the renal pelvis and ureter. Compare 52345 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 52345 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
$321.52
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 endoscopy
About 52345: Endoscopic incision of UPJ stricture
Reports ureteroscopic or pyeloscopic incision of a narrowed ureteropelvic junction to open the passage between the renal pelvis and ureter.
A urologist uses cystoscopy with ureteroscopy and/or pyeloscopy to reach a narrowed ureteropelvic junction and make an endoscopic incision to relieve the obstruction. This procedure, often described clinically as endopyelotomy, is performed in an operating room, generally for a UPJ narrowing that impedes urine drainage from the kidney into the ureter. The code is specific to the ureteropelvic junction, not a stricture farther down the ureter or within the renal pelvis.
Report the code when the operative record identifies the UPJ stricture and documents its endoscopic incision. Distinguish it from treatment of a UPJ stricture without incision and from incision at another urinary-tract site. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 52345
- 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
- Bilateral procedure with modifier 50 is paid at 150%.
- 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 RVU7.36 · 71%
- Practice expense (office) RVU2.06 · 20%
- Malpractice RVU0.95 · 9%
383
Medicare services in 2024 · #3773 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.
52345 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Both involve endoscopic incision, but 52344 is for a ureteral stricture and 52345 is for one at the ureteropelvic junction.
No office rate
Both specify incision, but 52346 is for a renal pelvis stricture; 52345 identifies the ureteropelvic junction.
Compare 52345 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
$321.52
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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 52345 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
6,148
- Code
- 52345
- Physician work
- 7.36
- Practice expense
- 2.06
- Malpractice
- 0.95
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.36 | × 1.000 | 7.3600 |
| Practice expense | 2.06 | × 0.958 | 1.9735 |
| Malpractice | 0.95 | × 0.308 | 0.2926 |
| Total RVUs | 9.6261 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$321.52
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.36 | 1 |
| Practice expense | 2.06 | 0.958 |
| Malpractice | 0.95 | 0.308 |
(7.36 × 1 + 2.06 × 0.958 + 0.95 × 0.308) × $33.4009 = $321.52
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.
52345 billing questions
How is this code different from 52342?
This code is for an incision of a ureteropelvic junction stricture. Code 52342 describes treatment of a UPJ stricture without specifying incision.
Can this code be used for a ureteral stricture below the UPJ?
No. It identifies incision at the ureteropelvic junction. An incision of a ureteral stricture is represented by 52344.
What operative details support reporting this code?
Document the stricture's location at the UPJ and that the surgeon incised it using cystoscopic access with ureteroscopy and/or pyeloscopy.
How should bilateral UPJ incisions be reported?
Use modifier 50 for a bilateral procedure. CMS pays the bilateral procedure at 150%.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
How are related endoscopies handled when performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together; payment follows that pricing method rather than treating each as an unrelated endoscopy.
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.
6,14552342,,Cysto w/up stricture tx,A,,5.70,1.72,NA,1.72,,0.73,8.15,8.15,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,14652343,,Cysto w/renal stricture tx,A,,6.39,1.85,NA,1.85,,0.82,9.06,9.06,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,14752344,,Cysto/uretero stricture tx,A,,6.87,1.96,NA,1.96,,0.89,9.72,9.72,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52000,33.4009,09,0,99,0.00,0.00,0.00
6,14852345,,Cysto/uretero w/up stricture,A,,7.36,2.06,NA,2.06,,0.95,10.37,10.37,0,000,0.00,0.00,0.00,3,1,0,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,14952346,,Cystouretero w/renal strict,A,,8.37,2.27,NA,2.27,,1.08,11.72,11.72,0,000,0.00,0.00,0.00,3,1,0,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
6,15052351,,Cystouretero & or pyeloscope,A,,5.61,1.66,NA,1.66,,0.71,7.98,7.98,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,15152352,,Cystouretero w/stone remove,A,,6.58,1.90,NA,1.90,,0.85,9.33,9.33,0,000,0.00,0.00,0.00,3,1,1,0,0,9,52351,33.4009,09,0,99,0.00,0.00,0.00
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,,,,,,