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    v1.0.30
    OpenPayerBilling CodesIncision Procedures on the KidneyCPT cpt-50081-percutaneous-antegrade-renal-ureteral-stone-removal-complex
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    CPT 50081: Percutaneous Antegrade Removal of Kidney/Ureteral Stones

    Medicare pays $1018 on average nationally for this procedure.

    CPT code 50081 describes a complex percutaneous antegrade stone removal procedure in which the provider removes one or more stones from the kidney, renal pelvis, or ureter using an antegrade (“downhill”) percutaneous approach with imaging guidance; the service type is percutaneous renal/ureteral stone removal and the typical site of service is an interventional radiology or operating room/procedure suite setting where stent and nephrostomy tube placement may occur.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 54-year-old male with a history of recurrent nephrolithiasis presents with severe left flank pain, hematuria, and obstructive symptoms. Imaging (non-contrast CT) demonstrates a 2.8 cm staghorn/complex stone occupying the renal pelvis with calyceal branching and associated hydronephrosis. The patient has failed conservative measures and previous ureteroscopy for smaller stones. The urology team schedules a percutaneous nephrolithotomy using an antegrade (downhill) approach under general anesthesia. Intraoperative fluoroscopic and ultrasound guidance are used to access the collecting system, dilate a nephrostomy tract, and fragment and remove stone burden. A nephrostomy tube and/or ureteral stent may be placed at procedure end. Typical workflow includes preoperative imaging and labs, anesthesia evaluation, image-guided percutaneous access, stone extraction and fragmentation (ultrasonic/pneumatic/laser), possible placement of a nephrostomy tube and/or internal stent, immediate postoperative imaging or nephrostogram as indicated, and inpatient observation for pain control, urine output, and infection monitoring. Typical indications include large renal calculi, staghorn stones, complex or branched stones, or stones not amenable to ureteroscopic or shock-wave lithotripsy approaches.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    50590Lithotripsy, extracorporeal shock wave (ESWL)Alternative, less-invasive therapy for renal/ureteral stones; may have been attempted prior to percutaneous approach.
    52332Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral)Endoscopic approach for ureteral/renal stones; may be used before or after PCNL for residual fragments or concurrently for distal ureteral stones.
    50390Nephrostomy, percutaneous or open, diagnostic and/or therapeuticPlacement of nephrostomy tube for drainage is often performed in association with percutaneous stone procedures or as a staged step.
    52332Ureteroscopy with lithotripsy (see above)Endoscopic adjunct for staged combined procedures to address residual calyceal fragments.
    51045Pyelotomy; incision of renal pelvis, with or without closure (rare)Rarely used for open or combined procedures when percutaneous access is converted to an open approach.
    51990Lithotripsy, direct visualization (endoscopic)Endoscopic fragmentation techniques that may be used in adjunct to percutaneous access.

    Note: If a listed code is not applicable in a specific case, billing should follow payer rules and documentation of the clinical workflow.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    2086S0102X
    208D00000X
    2084P0005X
    174H00000X
    3418M1120X
    208M00000X
    364SC2300X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    E87.0Hyperosmolality and hypernatremia
    E87.5Hyperkalemia
    I12.9Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
    N04.9Nephrotic syndrome with unspecified morphologic changes
    N11.0Nonobstructive reflux-associated chronic pyelonephritis
    N11.1Chronic obstructive pyelonephritis
    N11.9Chronic tubulo-interstitial nephritis, unspecified
    N13.2Hydronephrosis with renal and ureteral calculous obstruction
    N13.6Pyonephrosis
    N20.0Calculus of kidney

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-50010-RENAL-DIAGNOSTIC-EXPLORATION-KIDNEY

    CPT 50010: Diagnostic Exploration of Kidney

    CPT-50020-OPEN-DRAINAGE-RENAL-PERIRENAL-ABSCESS

    CPT 50020: Open Drainage of Renal or Perirenal Abscess

    CPT-50040-CREATION-OF-RENAL-CUTANEOUS-FISTULA-NEPHROSTOMY

    CPT 50040: Open Nephrostomy for Urinary Obstruction

    CPT-50045-URINARY-OBSTRUCTION-RELIEF-SURGICAL-PROCEDURE

    CPT 50045: Surgical Relief of Urinary Tract Obstruction

    CPT-50060-SURGICAL-REMOVAL-KIDNEY-STONE

    CPT 50060: Surgical Removal of Kidney Stones (Nephrolithiasis)

    CPT-50065-NEPHROLITHOTOMY-SECONDARY-PROCEDURE-RENAL-STONE-REMOVAL

    CPT 50065: Nephrolithotomy for Kidney Stone Removal

    CPT-50070-KIDNEY-INCISION-STONE-REMOVAL-CONGENITAL-MALFORMATION

    CPT 50070: Nephrolithotomy for Renal Calculi with Kidney Malformation

    CPT-50075-OPEN-NEPHROLITHOTOMY-STAGHORN-CALCULUS-REMOVAL

    CPT 50075: Nephrolithotomy for Staghorn Renal Calculus

    CPT-50080-PERCUTANEOUS-ANTEGRADE-RENAL-STONE-REMOVAL-SIMPLE

    CPT 50080: Percutaneous Nephrolithotomy, Antegrade Stone Removal (Simple)

    CPT-50100-UPJ-REPAIR-RENAL-VESSEL-REPOSITIONING

    CPT 50100: Reposition/Incision of Aberrant Renal Vessels for UPJ Obstruction

    Showing 1–10 of 13

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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