Summary & Overview
CPT 50236: Nephrectomy (Kidney Removal)
CPT code 50236 denotes a nephrectomy, the surgical removal of a kidney or part of a kidney. Nephrectomy is a critical operative procedure for conditions such as renal malignancy, severe renal trauma, or nonfunctional renal units, and it carries implications for surgical planning, perioperative care, and post-acute management nationwide. This analysis covers major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare to provide a broad national perspective.
Readers will find a concise overview of the clinical context for CPT code 50236, typical sites of service, and the payer landscape affecting coverage and billing for nephrectomy procedures. The publication summarizes common billing considerations, typical modifiers in use, and where to find related coding and documentation guidance. It also outlines benchmarks and policy references relevant to surgical coding and reimbursement for nephrectomy, and highlights areas where clinicians and billing professionals should confirm coverage details with individual payers.
Data not provided in the input, such as specific ICD-10 pairings, payer-specific reimbursement rates, and associated taxonomies, are noted as unavailable and are not included in this summary.
Billing Code Overview
CPT code 50236 represents a nephrectomy, a surgical procedure for removal of a kidney or part of a kidney. This service is a surgical intervention addressing conditions such as renal tumors, severe trauma, nonfunctional kidney, or other pathology requiring partial or complete kidney removal.
Typical site of service for CPT code 50236 is an inpatient or outpatient surgical setting, including hospital operating rooms and ambulatory surgical centers, depending on clinical complexity and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a 3-cm enhancing mass in the interpolar region of the right kidney is scheduled for a partial nephrectomy (nephron-sparing surgery). The patient presents with hypertension and chronic kidney disease stage 2. Preoperative evaluation includes cross-sectional abdominal imaging (CT or MRI), baseline serum creatinine and estimated glomerular filtration rate, urinalysis, and anesthetic assessment. On the day of surgery the patient is admitted to an outpatient or inpatient surgical unit depending on comorbidities. The urologic surgeon performs a transperitoneal laparoscopic partial nephrectomy with intraoperative renal hilum control, tumor excision with negative margins, and renorrhaphy. Postoperative care includes monitoring renal function, pain control, DVT prophylaxis, and surveillance imaging per oncology/urology protocol. Typical site of service is an ambulatory surgery center or hospital operating room. The service type is a major surgical procedure (nephrectomy/partial nephrectomy) performed by a urologist (or transplant/vascular-surgeon in select cases).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When both kidneys are operated on during the same operative session (rare for nephrectomy codes). |
62 |