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    OpenPayerBilling CodesRepair Procedures on the KidneyCPT cpt-50520-nephrocutaneous-pyelocutaneous-fistula-closure
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    CPT 50520: Nephrocutaneous and Pyelocutaneous Fistula Closure

    Medicare pays $1103 on average nationally for this procedure.

    CPT code 50520 describes surgical repair of a nephrocutaneous or pyelocutaneous fistula, a procedure to close an abnormal communication between the kidney or renal pelvis and the skin; service type: fistula closure (surgical repair); typical site of service: operating room or ambulatory surgery center for a urologic reconstructive procedure involving the renal unit and overlying skin.

    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 typical patient is a middle-aged adult who presents with a persistent draining tract from the flank or posterior abdominal wall after prior renal surgery, percutaneous renal procedure, or chronic infection. The patient reports intermittent drainage, localized pain, and recurrent skin irritation around the fistulous opening. Evaluation includes physical exam, laboratory studies (CBC, inflammatory markers), urinalysis and urine culture, and imaging such as contrast-enhanced CT abdomen/pelvis or fistulography to define the tract between the skin and the kidney or renal pelvis. When conservative measures (antibiotics, wound care, drainage) are unsuccessful, a surgical repair is scheduled.

    Clinical workflow: preoperative assessment and optimization, imaging review to delineate tract, informed consent discussing risks (bleeding, infection, injury to urinary collecting system), anesthesia evaluation (general or regional), operative planning for excision and layered closure of the nephrocutaneous or pyelocutaneous fistula, possible intraoperative placement of ureteral stent or nephrostomy tube if indicated, postoperative wound care, antibiotics guided by cultures, and follow-up imaging or clinic visits to confirm fistula closure and wound healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    50525Nephrectomy, partial; with corticoplasty, including repair of renal pelvis when indicatedPerformed if diseased renal parenchyma requires resection during complex fistula repair
    52000Cystourethroscopy, with or without irrigation and catheterization; diagnostic, with or without collection of specimen(s)Used preoperatively to evaluate lower urinary tract or identify concomitant sources of drainage
    51040Drainage of renal abscess, percutaneous needle/ catheterMay be performed before definitive fistula closure to control infection
    53860Nephrostomy, percutaneous, with imaging guidancePlacement of nephrostomy tube can divert urine away from fistula to facilitate healing prior to or during repair
    76942Ultrasonic guidance for needle placementUsed when image-guided drainage or nephrostomy placement is performed in conjunction with management
    11043Debridement, muscle and/or fascia; 30 sq cm or lessSoft-tissue debridement of infected or necrotic tissue surrounding the fistula prior to definitive closure

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208U00000X
    207T00000X
    207L00000X
    207RA0002X
    2088F0040X
    125K00000X
    364SS0200X
    207ZM0300X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    K59.2Neurogenic bowel, not elsewhere classified
    N10Acute pyelonephritis
    N11.9Chronic tubulo-interstitial nephritis, unspecified
    N12Tubulo-interstitial nephritis, not specified as acute or chronic
    N13.2Hydronephrosis with renal and ureteral calculous obstruction
    N13.6Pyonephrosis
    N13.8Other obstructive and reflux uropathy
    N15.1Renal and perinephric abscess
    N17.9Acute kidney failure, unspecified
    N18.6End stage renal disease

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Nephrology1 / 2

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

    CPT 50433: Percutaneous Nephrostomy Catheter Placement

    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-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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