CPT 52332 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 52332: Cystourethroscopy with Indwelling Ureteral Stent Placement

CPT code 52332 is a nationally recognized billing code for cystourethroscopy with insertion of an indwelling ureteral stent, a critical urological procedure used to treat urinary tract obstructions and related conditions. This code is widely utilized in hospital outpatient departments and ambulatory surgical centers, reflecting its importance in both routine and urgent urological care. The procedure is performed by board-certified urology physicians and is essential for managing patients with conditions such as hydronephrosis, ureteral calculi, and obstructive uropathy.

Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad national access and reimbursement. Readers will gain insight into clinical indications, typical sites of service, and payer coverage benchmarks. The publication also highlights relevant policy updates, coding nuances, and the clinical context for the use of 52332, including its relationship to other urological procedures and common billing modifiers. This summary provides a comprehensive overview for healthcare professionals, administrators, and policy analysts seeking to understand the significance and utilization of this CPT code in the current healthcare landscape.

AetnaBlue Cross Blue ShieldCigna HealthMedicareUnitedHealthcareCPT 52332UrologyTransurethral SurgeryCystourethroscopyIndwelling Ureteral StentHospital OutpatientAmbulatory Surgical CenterMedical BillingClinical BenchmarkingPolicy Updates

CPT Code Overview

CPT code 52332 describes a cystourethroscopy with insertion of an indwelling ureteral stent, such as a Gibbons or double J-type stent. This procedure is performed by urology specialists to address urinary tract obstructions or other conditions requiring stent placement. It is classified as a transurethral surgical procedure within the field of urology. The typical site of service for this procedure is the operating room in either a hospital outpatient setting or an ambulatory surgical center, commonly designated as POS 22 or 24.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult presenting with symptoms of urinary obstruction, such as flank pain or hematuria, due to a ureteral stone or hydronephrosis. The patient is evaluated by a urology physician in a hospital outpatient operating room or ambulatory surgical center (POS 22 or 24). After diagnostic imaging confirms obstruction, the physician performs a cystourethroscopy and inserts an indwelling ureteral stent (such as a Gibbons or double J-type) to relieve the obstruction and restore urine flow. This procedure is often performed when immediate stone removal is not possible or as a temporizing measure before definitive treatment.

Coding Specifications

Modifier 59: Used to indicate a distinct procedural service, such as permanent stent insertion that is separate from a diagnostic or therapeutic intervention performed during the same session.

Modifier Code	Description
`59`	Distinct procedural service (permanent stent insertion separate from diagnostic/therapeutic intervention)

Provider Taxonomies:

National Reimbursement Benchmarks

National mean rates for CPT code 52332 show that UnitedHealth Group has the highest average reimbursement at $618.40, while Medicare's mean rate is $386.60. The BUCA (average commercial) mean rate stands at $424.95, which is notably higher than Medicare but significantly lower than UnitedHealth Group.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the tightest range ($45.00), indicating relatively consistent rates. In contrast, UnitedHealth Group has the widest dispersion ($315.67), reflecting substantial variability in commercial reimbursement. Cigna and Blue Cross Blue Shield also show broad ranges, while Aetna and BUCA are more moderate.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 52332 are notably higher than national averages across all major payers. The mean rates for commercial payers such as Aetna, Blue Cross Blue Shield, Cigna, UnitedHealth Group, and BUCA are substantially above their respective national benchmarks, with Aetna's mean rate in Alaska more than triple its national mean. Medicare's mean rate in Alaska is slightly below the national average, but still within a comparable range.

The rate spread, calculated as the difference between the 75th and 25th percentiles, varies significantly among payers. Blue Cross Blue Shield exhibits the widest spread at $350.84, indicating considerable variability in reimbursement, while Aetna's spread is narrower at $139.00. The table and chart below present the full breakdown of payer-specific rates in Alaska, highlighting the substantial differences in reimbursement across payers.

Key Insights for Alaska

Aetna is the highest paying payer in Alaska for CPT 52332, with a mean rate of $1,071.24, while Medicare is the lowest at $373.14.
All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with Aetna's mean rate more than triple the national mean.
The rate spread is widest for Aetna ($139.00) and BCBS ($350.84), indicating substantial variability in commercial payer reimbursement.

CPT 52341: Cystourethroscopy with Treatment of Ureteral Stricture

CPT-52325-URETERAL-LITHOTRIPSY-CYSTOURETHROSCOPY

CPT 52325: Cystourethroscopy with Ureteral Lithotripsy

CPT-52344-CYSTOURETHROSCOPY-URETERAL-STRICTURE-TREATMENT-URETEROSCOPY

CPT 52344: Cystourethroscopy with Ureteral Stricture Treatment

CPT-52320-CYSTOURETHROSCOPY-URETERAL-STONE-REMOVAL

CPT 52320: Cystourethroscopy with Ureteral Catheterization and Stone Removal

CPT-52343-CYSTOURETHROSCOPY-WITH-INTRARENAL-STRICTURE-TREATMENT

CPT 52343: Cystourethroscopy with Intrarenal Stricture Treatment

CPT-52342-CYSTOURETHROSCOPY-WITH-URETERAL-CATHETER-TO-UPJ-FOR-UPJ-STRICTURE-TREATMENT

CPT 52342: Cystourethroscopy with Ureteral Catheterization to UPJ for Stricture Treatment

CPT-52355-URETERAL-PELVIC-TUMOR-RESECTION-CYSTOURETHROSCOPY-URETEROSCOPY

CPT 52355: Cystourethroscopy with Ureteroscopic/Pyeloscopic Tumor Resection

CPT-52352-CYSTOURETHROSCOPY-URETEROSCOPY-STONE-REMOVAL

CPT 52352: Cystourethroscopy with Ureteroscopy/Pyeloscopy for Stone Removal

CPT-52346-CYSTOURETHROSCOPY-AND-INTRARENAL-STRICTURE-TREATMENT

CPT 52346: Cystourethroscopy with Ureteroscopy for Intrarenal Stricture

CPT-52354-CYSTOURETHROSCOPY-URETEROSCOPY-PYELOSCOPY-LESION-BIOPSY-FULGURATION

CPT 52354: Cystourethroscopy with Ureteroscopy/Pyeloscopy, Lesion Biopsy or Fulguration

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`208800000X`	Urology Physician
`2088P0231X`	Pediatric Urology Physician
`2088F0040X`	Female Pelvic Medicine and Reconstructive Surgery Physician

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Summary & Overview

CPT 52332: Cystourethroscopy with Indwelling Ureteral Stent Placement

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes