Summary & Overview
CPT 50400: Pyeloplasty for Ureteropelvic Junction Obstruction
CPT code 50400 denotes pyeloplasty, the surgical reconstruction of an obstruction at the ureteropelvic junction to reestablish urine flow from the renal pelvis into the ureter. This procedure is a key intervention for obstructive uropathy that can preserve kidney function and prevent complications such as hydronephrosis and recurrent infections. Nationally, pyeloplasty is performed across hospital operating rooms and ambulatory surgical centers and is relevant to surgical, urology, and nephrology service lines.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for pyeloplasty, typical sites of service, and what to expect in billing and claim review for this surgical code. The publication provides benchmarks, payer coverage patterns, and policy considerations affecting authorization and claim adjudication where available. When input data is incomplete, the publication notes that certain detailed fields are not available in the input.
This summary is intended for coding professionals, revenue cycle staff, and clinicians seeking a concise reference on CPT code 50400, its clinical purpose, and the payer landscape affecting reimbursement and utilization at a national level.
Billing Code Overview
CPT code 50400 describes pyeloplasty, a surgical procedure to correct an obstruction at the junction between the renal pelvis and the ureter. The provider surgically reconstructs the area of blockage to restore urine flow from the kidney into the ureter and preserve renal function.
Service Type: Surgical repair of ureteropelvic junction obstruction
Typical Site of Service: Inpatient or outpatient hospital operating room; ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is a 28–45-year-old adult presenting with recurrent flank pain, intermittent urinary tract infections, or impaired renal function found on imaging. Evaluation includes renal ultrasound, CT urogram or MAG3 renal scan demonstrating ureteropelvic junction (UPJ) obstruction with hydronephrosis and either preserved or decreasing differential renal function. After conservative management or endoscopic attempts fail or are unsuitable, the urologist schedules an operative pyeloplasty to surgically reconstruct the obstructed UPJ and restore drainage.
Preoperative workflow includes history and physical, review of imaging and nuclear renal scan, preoperative labs (basic metabolic panel, coagulation as indicated), anesthesia evaluation, and informed consent documenting indication and planned approach (open, laparoscopic or robotic). Intraoperative steps include exposure of the renal pelvis and UPJ, excision of the stenotic segment when indicated, spatulated ureteral reimplantation or anastomosis to the renal pelvis with stent placement as needed, hemostasis, and wound closure. Postoperative care includes pain control, monitoring urine output, early ambulation, and imaging follow-up (ultrasound or diuretic renogram) to confirm resolution of obstruction. Typical sites of service are the hospital operating room or ambulatory surgical center, with inpatient stay possible depending on approach and comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |