Summary & Overview
CPT 0942T: Endoscopic Removal and Replacement of Prostatic Urethral Scaffold
CPT code 0942T designates endoscopic removal of an existing prostatic urethral scaffold with placement of a replacement scaffold using a flexible cystourethroscope. This procedure addresses urethral narrowing related to prostatic conditions by restoring or maintaining urethral patency. Nationally, the code is relevant for urology practices and facilities that manage obstructive lower urinary tract conditions where prior scaffolds require revision or replacement.
Key payers considered in national coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of clinical context, common care settings, and payer coverage patterns where available. The publication summarizes coding considerations, common modifiers in use, and how the service typically presents on a surgical service line. It also outlines benchmarks and policy developments affecting utilization and claims processing when such information is available.
The report provides actionable reference material for billing and compliance teams, revenue cycle leaders, and clinical program managers seeking clarity on coding description, typical service sites, and payer engagement for scaffold revision procedures. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 0942T describes endoscopic removal and replacement of a prostatic urethral scaffold using a flexible cystourethroscope. The procedure involves removing an existing scaffold that was previously placed to maintain urethral patency and inserting a new scaffold to restore or preserve urinary flow.
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Service type: Endoscopic scaffold removal and replacement
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Typical site of service: Ambulatory surgical center or hospital outpatient setting
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of benign prostatic hyperplasia (BPH) previously treated with placement of a prostatic urethral scaffold presents with progressive lower urinary tract symptoms including weak stream, urinary hesitancy, and recurrent urinary retention. Cystoscopic evaluation demonstrates migration and partial obstruction from the existing scaffold with recurrent urethral narrowing. The treating urologist schedules removal of the malfunctioning scaffold and replacement with a new prostatic urethral scaffold using a flexible cystourethroscope under monitored anesthesia care. Peri-procedural workflow includes preoperative assessment, informed consent documenting risks of scaffold removal and replacement, administration of prophylactic antibiotics per local protocol, intraoperative cystoscopic removal of the existing device and deployment of the new scaffold, immediate cystoscopic confirmation of position and patency, and postoperative voiding trial prior to discharge with outpatient follow-up for symptom assessment and device surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work, time, or technical difficulty exceeds typical for scaffold removal/replacement and documentation supports unusual complexity. |
51 | Multiple procedures | Use when billing multiple distinct procedures during the same operative session in addition to scaffold replacement (if payer accepts modifier 51). |
52 | Reduced services | Use if the procedure was partially completed or limited relative to full service (e.g., attempted removal but incomplete replacement). |
53 | Discontinued procedure | Use when the procedure is started but terminated for patient-related or intraoperative reasons before completion. |
62 | Two surgeons | Use when two surgeons of different specialties work together as primary surgeons throughout the procedure. |
66 | Team surgeon | Use when a team of surgeons from the same specialty performs the procedure as defined by payer policy. |
73 | Discontinued prior to anesthesia | Use when the procedure is cancelled after anesthesia start but before its completion due to intraoperative circumstances. |
78 | Unplanned return to OR for related procedure during global period | Use when the patient returns to the operating room unexpectedly for a related scaffold revision during the global postoperative period. |
80 | Assistant surgeon | Use when an assistant surgeon provides intraoperative help and documentation supports assistant services. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Use when an APP acts as the surgical assistant and payer allows billing with modifier AS. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Urology | Board-certified urologists commonly perform endoscopic scaffold removal and replacement. |
| 208000000X | General Surgery | Selected general surgeons with endourology training may perform urologic endoscopic procedures in some settings. |
| 207RP0220X | Female Pelvic Medicine & Reconstructive Surgery | Urologic subspecialists focusing on pelvic reconstructive procedures may manage complex urethral devices. |
| 363L00000X | Physician Assistant | APPs commonly assist in perioperative care and may serve as surgical assistants where permitted. |
| 363A00000X | Nurse Practitioner | NPs often provide pre- and postoperative management and may assist intraoperatively depending on state law. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N40.0 | Enlarged prostate with lower urinary tract symptoms | Common indication for prostatic urethral scaffold placement and for revision when symptoms recur. |
N13.8 | Other obstructive and reflux uropathy | May describe complex obstructive etiologies where scaffolding is used to maintain urethral patency. |
N35.1 | Urethral stricture, male | Urethral narrowing that can be managed with scaffold placement or require scaffold revision if obstruction recurs. |
R33.9 | Retention of urine, unspecified | Acute or chronic urinary retention prompting evaluation and device revision. |
T83.898A | Other specified complications of genitourinary device, implant and graft, initial encounter | Used for complications related to scaffold malfunction, migration, encrustation, or infection requiring removal/replacement. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
0524T | Removal of prostatic urethral scaffold using cystourethroscope | May be billed when removal occurs as a separate, standalone procedure; relates to the removal component prior to replacement. |
0547T | Placement of prostatic urethral scaffold using cystourethroscope | May be billed for the insertion/deployment component when performed separately; relates to the replacement component. |
52000 | Cystourethroscopy (separate procedure) | Diagnostic cystourethroscopy performed for evaluation before or after scaffold work; often used for inspection and confirmation of device position. |
52332 | Cystourethroscopy, with removal of foreign body, with or without dilation | May be used when additional endoscopic removal maneuvers for device fragments or encrustation are required during scaffold revision. |
51702 | Insertion of temporary indwelling bladder catheter (e.g., straight or Foley) | Often performed intra- or post-operatively to allow drainage and a voiding trial after scaffold replacement. |