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CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

CPT code 50405 represents pyeloplasty, a surgical procedure to correct obstruction between the renal pelvis and ureter. Nationally, pyeloplasty is a cornerstone urologic operation for relieving ureteropelvic junction obstruction, preserving renal function, and preventing recurrent infections and pain. Accurate coding supports appropriate payment, quality tracking, and case-mix measurement for surgical services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. The discussion addresses clinical context for the procedure, typical sites of service, and common billing considerations used by these major payers.

Readers will find a concise clinical overview of the procedure, guidance on where the service is typically delivered, and what to expect in payer review and utilization contexts. The publication outlines benchmarking and policy topics relevant to pyeloplasty coding, including coding specificity, service-line classification, and factors that influence coverage and site-of-service decisions. Data not available in the input will be noted explicitly where applicable. This summary is intended for clinicians, coding professionals, and policy analysts seeking a national-level briefing on CPT code 50405 and its role in surgical urology services.

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Billing Code Overview

CPT code 50405 describes pyeloplasty, a surgical reconstruction performed to correct an obstruction at the junction between the renal pelvis and the ureter. The procedure involves surgically reconstructing the area of blockage where the ureter enters the renal pelvis to restore normal urine flow and preserve renal function.

Service type: Surgical reconstructive urologic procedure

Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical complexity and facility capabilities.

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CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

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Billing Code Overview

Service type: Surgical reconstructive urologic procedure

Typical site of service: Inpatient or outpatient hospital operating room or ambulatory surgical center, depending on clinical complexity and facility capabilities.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 28–45-year-old adult presenting with flank pain, recurrent urinary tract infections, and/or impaired renal function attributed to ureteropelvic junction (UPJ) obstruction. Workup includes renal ultrasound demonstrating hydronephrosis, diuretic renal scintigraphy showing diminished drainage or differential renal function, and cross-sectional imaging (CT urogram or MR urogram) to define anatomy. After conservative measures or endoscopic attempts fail or when anatomical obstruction is severe, the urologist schedules a 50405 pyeloplasty. The procedure is most often performed in an inpatient or ambulatory surgical center operating room under general anesthesia. Typical workflow: preoperative evaluation and informed consent; anesthesia induction and patient positioning; exposure of the renal pelvis and proximal ureter via an open or minimally invasive approach; excision of the obstructed segment and reconstruction of the ureteropelvic junction with or without transposition of a crossing vessel; placement of a ureteral stent as indicated; intraoperative assessment of urine drainage; postoperative monitoring in PACU with pain control, urinary stent management, and imaging follow-up (renal ultrasound or diuretic renogram) to confirm improved drainage. Common perioperative providers include urologists (pediatric or adult), anesthesiologists, surgical nurses, and radiology for pre/post imaging.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative complexity or extended surgical time significantly exceeds typical for `50405` and documentation supports additional work.
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia that would ordinarily be done with local/monitored anesthesia care due to unusual circumstances.
`26`	Professional component	Use when reporting only the physician professional component separate from facility or technical components (rare for surgical procedures billed by facility).
`50`	Bilateral procedure	Use when both kidneys/UPJs are repaired during the same operative session and payer accepts bilateral modifier usage for this code.
`51`	Multiple procedures	Use when additional distinct procedures are performed in the same operative session (report reductions as required by payer policy).
`52`	Reduced services	Use when the pyeloplasty is started but not completed and documentation supports a reduced service.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances and documentation supports cancellation.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the `50405` procedure.
`78`	Return to OR for related procedure during global period	Use for an unplanned return to the operating room for a related procedure during the global period following `50405`.
`79`	Unrelated procedure or service by same physician during global period	Use when an unrelated procedure is performed during the global period for `50405`.
`RT`	Right side	Use to identify procedures performed on the right kidney/UPJ when laterality reporting is required.
`LT`	Left side	Use to identify procedures performed on the left kidney/UPJ when laterality reporting is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services rendered in facility setting	Use when a qualified non-physician practitioner performs portions of care and billing rules permit.
`62`	Co-surgeon	(See above) Use when co-surgeon performs distinct operative work.

Taxonomy Code	Specialty	Notes
`208800000X`	Urology	Primary specialty performing `50405`.
`208D00000X`	Pediatric Urology	Performs pyeloplasty for congenital UPJ obstruction in children.
`207L00000X`	Surgical Oncology (Urologic surgical subspecialists)	May perform complex reconstructive renal pelvis surgery in select cases.
`208200000X`	General Surgery	Occasionally involved in complex retroperitoneal exposures or multi-disciplinary cases.
`208600000X`	Anesthesiology	Provides general anesthesia and intraoperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N13.0`	Hydronephrosis with obstruction of kidney	Primary diagnosis for UPJ obstruction leading to pyeloplasty; indicates dilation from obstruction.
`Q62.0`	Congenital obstructive defects of kidney, not elsewhere classified	Represents congenital UPJ obstruction commonly corrected by pyeloplasty in pediatric patients.
`N13.6`	Pyelonephritis with obstruction	Acute or chronic infection in the setting of obstruction that may necessitate surgical correction.
`N20.0`	Calculus of kidney	Renal calculi can cause or coexist with UPJ obstruction and influence surgical planning.
`N26.89`	Other contracted kidney	Chronic renal changes from longstanding obstruction that may prompt reconstructive intervention.
`R33.9`	Retention of urine, unspecified	May be used when obstructive symptoms impair drainage, though less specific for UPJ obstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`50400`	Repair of ureteropelvic junction; pyeloplasty, open approach	Closely related alternative code representing open pyeloplasty technique; may be used when documentation specifies open versus reconstructive approach.
`50590`	Lithotripsy, extracorporeal shock wave (ESWL)	Performed preoperatively or postoperatively for concurrent renal calculi that may contribute to obstruction.
`52000`	Cystourethroscopy, diagnostic, with or without collection of specimen(s)	Used for diagnostic endoscopic evaluation of the bladder and ureteral orifice preoperatively or intraoperatively for stent placement.
`52332`	Cystourethroscopy; with ureteral stent placement (with or without cystoscopic removal)	Used when intraoperative or postoperative stent placement is required as part of the pyeloplasty procedure.
`77850`	Radioisotope renal imaging; renal cortical imaging, including renal scan (e.g., MAG3 diuretic renogram)	Common preoperative and postoperative functional assessment to document obstruction and improved drainage after `50405`.
`49010`	Drainage of renal or perinephric abscess, open or percutaneous	May be performed prior to definitive pyeloplasty if infection or abscess complicates the clinical course.

CPT 50400: Pyeloplasty for Ureteropelvic Junction Obstruction

CPT-50430-PERCUTANEOUS-URETEROGRAM-NEPHROSTOGRAM-DIAGNOSTIC

CPT 50430: Percutaneous Ureterogram/Nephrostogram Diagnostic Study

CPT-50431-NEPHROSTOGRAM-URETEROGRAM-CONTRAST-STUDY

CPT 50431: Nephrostogram or Ureterogram via Existing Access

CPT-50432-PERCUTANEOUS-NEPHROSTOMY-WITH-IMAGING-GUIDANCE

CPT 50432: Image-Guided Percutaneous Renal Pelvis Catheter Placement

CPT-50433-PERCUTANEOUS-NEPHROSTOMY-IMAGE-GUIDED-RENAL-DRAINAGE

CPT 50433: Image-Guided Percutaneous Nephrostomy

CPT-50434-PERCUTANEOUS-NEPHROSTOMY-TO-NEPHROURETERAL-CONVERSION

CPT 50434: Percutaneous Nephrostomy to Nephroureteral Catheter Conversion

CPT-50435-PERCUTANEOUS-NEPHROSTOMY-CATHETER-EXCHANGE-IMAGE-GUIDANCE

CPT 50435: Percutaneous Nephrostomy Catheter Exchange with Image Guidance

CPT-50500-KIDNEY-WOUND-SUTURE-REPAIR

CPT 50500: Suture Repair of Kidney Wound

CPT-50520-NEPHROCUTANEOUS-PYELOCUTANEOUS-FISTULA-CLOSURE

CPT 50520: Closure of Nephrocutaneous or Pyelocutaneous Fistula

CPT-50525-RENAL-FISTULA-CLOSURE-ABDOMINAL-APPROACH

CPT 50525: Renal Fistula Closure, Abdominal Approach

Showing 1–10 of 12

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when intraoperative complexity or extended surgical time significantly exceeds typical for `50405` and documentation supports additional work.
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia that would ordinarily be done with local/monitored anesthesia care due to unusual circumstances.
`26`	Professional component	Use when reporting only the physician professional component separate from facility or technical components (rare for surgical procedures billed by facility).
`50`	Bilateral procedure	Use when both kidneys/UPJs are repaired during the same operative session and payer accepts bilateral modifier usage for this code.
`51`	Multiple procedures	Use when additional distinct procedures are performed in the same operative session (report reductions as required by payer policy).
`52`	Reduced services	Use when the pyeloplasty is started but not completed and documentation supports a reduced service.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances and documentation supports cancellation.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the `50405` procedure.
`78`	Return to OR for related procedure during global period	Use for an unplanned return to the operating room for a related procedure during the global period following `50405`.
`79`	Unrelated procedure or service by same physician during global period	Use when an unrelated procedure is performed during the global period for `50405`.
`RT`	Right side	Use to identify procedures performed on the right kidney/UPJ when laterality reporting is required.
`LT`	Left side	Use to identify procedures performed on the left kidney/UPJ when laterality reporting is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services rendered in facility setting	Use when a qualified non-physician practitioner performs portions of care and billing rules permit.
`62`	Co-surgeon	(See above) Use when co-surgeon performs distinct operative work.

Taxonomy Code	Specialty	Notes
`208800000X`	Urology	Primary specialty performing `50405`.
`208D00000X`	Pediatric Urology	Performs pyeloplasty for congenital UPJ obstruction in children.
`207L00000X`	Surgical Oncology (Urologic surgical subspecialists)	May perform complex reconstructive renal pelvis surgery in select cases.
`208200000X`	General Surgery	Occasionally involved in complex retroperitoneal exposures or multi-disciplinary cases.
`208600000X`	Anesthesiology	Provides general anesthesia and intraoperative management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N13.0`	Hydronephrosis with obstruction of kidney	Primary diagnosis for UPJ obstruction leading to pyeloplasty; indicates dilation from obstruction.
`Q62.0`	Congenital obstructive defects of kidney, not elsewhere classified	Represents congenital UPJ obstruction commonly corrected by pyeloplasty in pediatric patients.
`N13.6`	Pyelonephritis with obstruction	Acute or chronic infection in the setting of obstruction that may necessitate surgical correction.
`N20.0`	Calculus of kidney	Renal calculi can cause or coexist with UPJ obstruction and influence surgical planning.
`N26.89`	Other contracted kidney	Chronic renal changes from longstanding obstruction that may prompt reconstructive intervention.
`R33.9`	Retention of urine, unspecified	May be used when obstructive symptoms impair drainage, though less specific for UPJ obstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`50400`	Repair of ureteropelvic junction; pyeloplasty, open approach	Closely related alternative code representing open pyeloplasty technique; may be used when documentation specifies open versus reconstructive approach.
`50590`	Lithotripsy, extracorporeal shock wave (ESWL)	Performed preoperatively or postoperatively for concurrent renal calculi that may contribute to obstruction.
`52000`	Cystourethroscopy, diagnostic, with or without collection of specimen(s)	Used for diagnostic endoscopic evaluation of the bladder and ureteral orifice preoperatively or intraoperatively for stent placement.
`52332`	Cystourethroscopy; with ureteral stent placement (with or without cystoscopic removal)	Used when intraoperative or postoperative stent placement is required as part of the pyeloplasty procedure.
`77850`	Radioisotope renal imaging; renal cortical imaging, including renal scan (e.g., MAG3 diuretic renogram)	Common preoperative and postoperative functional assessment to document obstruction and improved drainage after `50405`.
`49010`	Drainage of renal or perinephric abscess, open or percutaneous	May be performed prior to definitive pyeloplasty if infection or abscess complicates the clinical course.

CPT 50400: Pyeloplasty for Ureteropelvic Junction Obstruction

CPT-50430-PERCUTANEOUS-URETEROGRAM-NEPHROSTOGRAM-DIAGNOSTIC

CPT 50430: Percutaneous Ureterogram/Nephrostogram Diagnostic Study

CPT-50431-NEPHROSTOGRAM-URETEROGRAM-CONTRAST-STUDY

CPT 50431: Nephrostogram or Ureterogram via Existing Access

CPT-50432-PERCUTANEOUS-NEPHROSTOMY-WITH-IMAGING-GUIDANCE

CPT 50432: Image-Guided Percutaneous Renal Pelvis Catheter Placement

CPT-50433-PERCUTANEOUS-NEPHROSTOMY-IMAGE-GUIDED-RENAL-DRAINAGE

CPT 50433: Image-Guided Percutaneous Nephrostomy

CPT-50434-PERCUTANEOUS-NEPHROSTOMY-TO-NEPHROURETERAL-CONVERSION

CPT 50434: Percutaneous Nephrostomy to Nephroureteral Catheter Conversion

CPT-50435-PERCUTANEOUS-NEPHROSTOMY-CATHETER-EXCHANGE-IMAGE-GUIDANCE

CPT 50435: Percutaneous Nephrostomy Catheter Exchange with Image Guidance

CPT-50500-KIDNEY-WOUND-SUTURE-REPAIR

CPT 50500: Suture Repair of Kidney Wound

CPT-50520-NEPHROCUTANEOUS-PYELOCUTANEOUS-FISTULA-CLOSURE

CPT 50520: Closure of Nephrocutaneous or Pyelocutaneous Fistula

CPT-50525-RENAL-FISTULA-CLOSURE-ABDOMINAL-APPROACH

CPT 50525: Renal Fistula Closure, Abdominal Approach

Showing 1–10 of 12

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

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CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

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Billing Code Overview

CPT 50405: Pyeloplasty for Ureteropelvic Junction Obstruction

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure does CPT 50405 represent and where is it typically performed?

Which modifiers are listed as applicable to 50405 and when should they be used?

What preoperative imaging and clinical indications are described for performing a pyeloplasty (50405)?

What related CPT codes should be considered alongside 50405?

Which specialties and perioperative providers are involved in pyeloplasty as described?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure does CPT 50405 represent and where is it typically performed?

Which modifiers are listed as applicable to 50405 and when should they be used?

What preoperative imaging and clinical indications are described for performing a pyeloplasty (50405)?

What related CPT codes should be considered alongside 50405?

Which specialties and perioperative providers are involved in pyeloplasty as described?

References