Summary & Overview
CPT 50130: Removal of Calculus from Renal Pelvis
CPT code 50130 denotes surgical removal of a calculus from the renal pelvis, a targeted urologic procedure used to treat obstructing or symptomatic kidney stones. Nationally, this code matters because it captures a definitive surgical intervention that affects inpatient and outpatient resource use, perioperative care pathways, and claims adjudication for urologic stone disease. Payment and coverage policies for procedures addressing renal calculi influence access to operative management and downstream utilization of imaging and follow-up care.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and the primary use case for coding. The publication summarizes what to expect from benchmarking and payer coverage review, highlights policy and coding considerations that commonly affect claim processing, and outlines where to look for additional billing guidance. Where specific payer or claim-level benchmarks are not provided, the text notes that data are not available in the input.
This summary is written for a national audience of coding professionals, revenue cycle staff, and clinical managers seeking a clear briefing on CPT code 50130 and its role in documenting surgical removal of renal pelvic stones.
Billing Code Overview
CPT code 50130 describes the removal of calculus (stone) from the renal pelvis. This procedure involves surgical extraction of a stone located within the renal pelvis of the kidney.
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Service type: Surgical, stone removal from the renal pelvis
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to the emergency department with acute right flank pain, nausea, and hematuria. Non-contrast CT of the abdomen/pelvis demonstrates a 12 mm obstructing calculus located in the right renal pelvis with hydration and pain management initiated. The urology team evaluates the patient and recommends surgical removal of the renal pelvic stone due to size, symptoms, and obstruction. The patient is consented for a ureteroscopic or percutaneous approach depending on intraoperative findings. In the operating room under general anesthesia, the urologist performs stone extraction from the renal pelvis using appropriate instruments (ureteroscope with basket or percutaneous nephrolithotomy instruments). Intraoperative fluoroscopy may be used. The procedure code reported is 50130 for removal of calculus from the renal pelvis. Typical sites of service include the hospital operating room, ambulatory surgery center, or inpatient surgical suite. Post-procedure workflow includes recovery monitoring, pain control, imaging if indicated, and documentation of stone size, laterality, technique, any complications, and any devices left in place (stent or nephrostomy). Providers commonly involved are urologists and anesthesiologists; support staff include OR nurses and radiology technologists.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the work required to remove the stone is substantially greater than usual (extensive lysis of adhesions, prolonged operative time) and supported by documentation. |