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    v1.0.30
    OpenPayerBilling CodesRepair Procedures on the KidneyCPT cpt-50433-percutaneous-nephrostomy-image-guided-renal-drainage
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    CPT 50433: Percutaneous Nephrostomy Catheter Placement

    Medicare pays $1120 on average nationally for this procedure.

    CPT code 50433 describes percutaneous placement of a nephrostomy catheter using ultrasound and/or fluoroscopic real‑time imaging to create a new access tract into the renal collecting system for urinary diversion, optionally including injection of contrast for a nephrostogram or ureterogram; this is an image‑guided interventional radiology procedure typically performed in an interventional radiology suite, procedural room, or hospital operating room and is billed as a percutaneous nephrostomy catheter placement with radiological supervision and interpretation.

    For related coverage guidance, see recent payer policy updates: Vafseo (vadadustat) for anemia in CKD on dialysis, Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family Plans, Kerendia (finerenone) — Coverage Criteria.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with known right-sided renal calculi and progressive hydronephrosis presents with fever, flank pain, and rising serum creatinine. Imaging (CT abdomen/pelvis) demonstrates obstruction of the right renal pelvis from a 1.5 cm proximal ureteral stone with upstream dilatation and concern for infected obstructed kidney (pyonephrosis). The urology and interventional radiology teams coordinate care. The patient is brought to the interventional radiology suite where the operator uses ultrasound and fluoroscopic guidance to percutaneously access the renal collecting system and place a percutaneous nephrostomy catheter for urinary diversion. Contrast may be injected to perform a nephrostogram and antegrade ureterogram to delineate anatomy and locate the level of obstruction. The procedure creates a new percutaneous access tract, secures catheter position, and includes radiological supervision and interpretation. Typical workflow includes pre-procedure consent and coagulation review, procedural imaging and access, catheter placement and securement, immediate post-procedure imaging to confirm position and contrast drainage, and brief post-anesthesia recovery with instructions for catheter care and plans for definitive management (stone removal, stent placement, or delayed nephrostomy removal). Typical site of service is the hospital-based interventional radiology suite or ambulatory surgical center for stable patients; inpatient placement is common for infected obstruction or renal impairment requiring urgent decompression.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    50432Percutaneous nephrostomy catheter placement, initial; without imaging guidance (separate code for non-image-guided approaches)May be reported in limited settings if access is gained without image guidance; typically not used when ultrasound/fluoroscopy is employed.
    50392Nephrostomy or pyelostomy placement, percutaneous, with imaging guidance (diagnostic/therapeutic) — historically used in some coding setsRelated alternative codes in older or payer-specific coding; confirms the role of imaging guidance for access and drainage.
    74450Radiologic examination, antegrade pyelogram (nephrostogram), including fluoroscopic guidanceCommonly performed during the procedure to delineate collecting system anatomy and level of obstruction; contrast injection and imaging documented separately if billed.
    51702Per urethral catheterization, single or intermittent catheterization for drainage, simple (eg, straight catheterization)May be performed pre- or post-procedure for bladder drainage or contrast study coordination but is typically separate from nephrostomy placement.
    99500Infant or pediatric basic life support (if applicable)Applicable in pediatric or special circumstances requiring documented resuscitation preparedness; included here as an occasional adjunct.

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RG0100X
    208800000X
    363L00000X
    2080P0207X
    2084P0015X
    2081P2900X
    261QM1101X
    2472R0900X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    I82.409Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity
    I82.499Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity
    N11.1Chronic obstructive pyelonephritis
    N11.8Other chronic tubulo-interstitial nephritis
    N13.1Hydronephrosis with ureteral stricture, not elsewhere classified
    N13.2Hydronephrosis with renal and ureteral calculous obstruction
    N13.8Other obstructive and reflux uropathy
    N17.9Acute kidney failure, unspecified
    N18.6End stage renal disease
    N18.9Chronic kidney disease, unspecified

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Nephrology1 / 3

    10 rows

    PolicyPayerEffective Date
    Vafseo (vadadustat) for anemia in CKD on dialysisCigna2026-08-15
    Metabolic Disorders - Cysteamine (Oral) Products for Individual and Family PlansCigna2026-08-15
    Kerendia (finerenone) — Coverage CriteriaBlue Cross Blue Shield - Iowa2026-08-05
    Voyxact (sibeprenlimab-szsl) — Prior authorization / medical necessity for primary IgA nephropathyColorado Rocky Mountain Health Plans2026-08-01
    Oxlumo (lumasiran) and Rivfloza (nedosiran) — Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Korsuva (difelikefalin) — Medical Benefit Drug Coverage Criteria (Ohio)Colorado Rocky Mountain Health Plans2026-08-01
    Complement Inhibitors - EmpaveliCigna2026-08-01
    Tolvaptan (Jynarque)Cigna2026-08-01
    Nephrology - Filspari (sparsentan) coverageCigna2026-08-01
    Rivfloza (nedosiran) prior authorization for PH1UnitedHealthcare2026-08-01

    Related Codes

    CPT-50400-PYELOPLASTY-URETEROPELVIC-JUNCTION-REPAIR

    CPT 50400: Pyeloplasty, Ureteropelvic Junction Reconstruction

    CPT-50405-PYELOPLASTY-URETEROPELVIC-JUNCTION-RECONSTRUCTION

    CPT 50405: Pyeloplasty to Reconstruct Ureteropelvic Junction

    CPT-50430-PERCUTANEOUS-URETEROGRAM-NEPHROSTOGRAM-DIAGNOSTIC

    CPT 50430: Percutaneous Ureterogram/Nephrostogram with Contrast

    CPT-50431-NEPHROSTOGRAM-URETEROGRAM-CONTRAST-STUDY

    CPT 50431: Contrast Injection for Nephrostogram or Ureterogram

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

    CPT 50432: Percutaneous Nephrostomy Catheter Placement with Imaging

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

    CPT 50434: Image-Guided Nephrostomy to Nephroureteral Catheter Conversion

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

    CPT 50435: Percutaneous Nephrostomy Catheter Exchange with Imaging

    CPT-50500-KIDNEY-WOUND-SUTURE-REPAIR

    CPT 50500: Kidney Wound Suture

    CPT-50520-NEPHROCUTANEOUS-PYELOCUTANEOUS-FISTULA-CLOSURE

    CPT 50520: Nephrocutaneous and Pyelocutaneous Fistula Closure

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

    CPT 50525: Closure of Renal Fistula, Abdominal Approach

    Showing 1–10 of 12

    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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