Summary & Overview
CPT 50060: Surgical Removal of Kidney Stone
CPT code 50060 represents a surgical procedure for removal of kidney stones when conservative management fails. It matters nationally because urolithiasis is common and can require operative intervention to prevent renal damage, infection, and prolonged pain. Surgical treatment volume and reimbursement for stone removal influence hospital and outpatient surgical center resources and care pathways across the country.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and the payer landscape relevant to claims processing and coverage. The report summarizes payment benchmarks where available, common billing considerations, and recent policy updates affecting authorization and site-of-service determinations. Clinical context highlights indications for operative removal versus expectant management and the potential impact on utilization patterns.
This national summary is intended to help coding and revenue teams, policy analysts, and clinical leaders understand the role of CPT code 50060 in surgical management of urinary calculi, with guidance on where to look for payer-specific coverage rules and documentation requirements. Data not available in the input.
Billing Code Overview
CPT code 50060 describes a surgical procedure to treat kidney stones, which are crystallizations of minerals in the urine. The procedure is used when stones do not pass spontaneously and require operative removal to relieve obstruction, reduce pain, or prevent complications.
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Service type: Surgical removal of urinary calculi
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the emergency department with acute, severe right flank pain, nausea, and hematuria. Non-contrast CT confirms a 9 mm obstructing calculus in the proximal right ureter with hydronephrosis and persistent pain despite analgesics and medical expulsive therapy. Urology schedules an urgent endoscopic procedure to remove the stone. The patient undergoes cystoscopy with ureteroscopy and intracorporeal lithotripsy under general anesthesia. A ureteral stent is placed at the end of the case to ensure drainage and facilitate ureteral healing.
The clinical workflow includes preoperative evaluation (history, labs, imaging), informed consent, anesthesia clearance, operating room ureteroscopy with fragmentation and extraction of the stone, placement of a ureteral stent if indicated, immediate postoperative recovery and pain management, and a planned follow-up for stent removal within 1–2 weeks. Typical sites of service are the hospital operating room or ambulatory surgery center. The service type is endoscopic urologic stone removal.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician professional component separate from facility or technical services (rare for endoscopic stone removal but applicable if imaging interpretation is billed separately). |