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    OpenPayerBilling CodesRepair Procedures on the KidneyCPT cpt-50525-renal-fistula-closure-abdominal-approach
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    CPT 50525: Closure of Renal Fistula, Abdominal Approach

    Medicare pays $1388 on average nationally for this procedure.

    CPT code 50525 describes a surgical procedure to close a renal fistula such as a renocolic connection using an abdominal approach; the service is operative fistula repair of the kidney to adjacent organs and the typical site of service is an inpatient or ambulatory surgical setting where open abdominal urologic surgery is performed.

    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 an adult with a persistent renocolic fistula following renal surgery, trauma, infection, or diverticulitis eroding into adjacent renal tissue. The patient presents with recurrent urinary tract infections, fecaluria, passage of gas or stool in the urine, abdominal pain, fever, and possible sepsis. Diagnostic workup commonly includes urinalysis, urine culture, contrast-enhanced CT abdomen/pelvis to define the fistulous tract and associated abscess, and colonoscopy or contrast enema to evaluate colonic involvement. Preoperative optimization addresses infection control with targeted antibiotics, fluid resuscitation, and correction of electrolytes and coagulopathy.

    Surgical planning uses an open abdominal approach to gain adequate exposure for excision and primary closure of the fistulous tract, possible partial colectomy if colon involvement is extensive, and repair or partial nephrectomy if renal parenchyma is devitalized. Intraoperative steps include ureteral catheterization as indicated, control of contamination with irrigation and drainage, and placement of drains. Postoperative care includes broad-spectrum or culture-directed antibiotics, monitoring for leakage, wound care, pain control, and imaging or drain assessment. Typical site of service is an inpatient operating room. The service type is major surgical (open abdominal) urologic surgery performed by specialists in urology or, when colonic resection is required, in collaboration with general/colon and rectal surgery.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    50525Closure of renal fistula, abdominal approachPrimary procedure code for surgical closure of a reno‑enteric or renocolic fistula via the abdomen
    44140Colectomy, partial; single resection and anastomosisPerformed when segmental colonic resection is required for colonic involvement of the fistula
    50230Nephrectomy, radical, including perinephric fat, and/or partial nephrectomy codes (example)Performed when kidney is nonviable and removal is necessary; use exact nephrectomy CPT that matches extent (surgeon selects correct nephrectomy code)
    49422Removal of abdominal or retroperitoneal drainFor postoperative management when drains placed intraoperatively require removal in a separate encounter
    51702Bladder catheterization, single; simple catheter placementCommon intraoperative or postoperative procedure for urinary drainage and monitoring
    74350CT abdomen and pelvis with contrast, diagnosticPreoperative or postoperative imaging to define fistula anatomy and assess for complications

    Related Modifiers

    14 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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    54Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
    55Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
    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…

    Showing 1–10 of 14

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    208800000X
    207L00000X
    207K00000X
    261QI0500X
    1744G0900X
    3104A0625X
    364SX0200X

    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-50520-NEPHROCUTANEOUS-PYELOCUTANEOUS-FISTULA-CLOSURE

    CPT 50520: Nephrocutaneous and Pyelocutaneous Fistula Closure

    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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