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CPT 50590: Extracorporeal Shock Wave Lithotripsy for Kidney and Ureteral Stones
CPT code 50590 denotes extracorporeal shock wave lithotripsy (ESWL), a noninvasive therapeutic procedure to fragment kidney and ureteral calculi. ESWL remains a widely used first-line or adjunctive treatment for appropriately sized urinary stones, with implications for hospital outpatient and ambulatory surgical center workflows, equipment investment, and clinical pathways. Nationally, ESWL utilization affects imaging, ancillary services, and post-procedure outpatient follow-up.
This publication covers coverage and benchmarking information for major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise clinical description of the service, common diagnosis alignments, and related procedural codes that may appear on the same claim. The report outlines typical sites of service and the clinical context for ESWL, and highlights common coding relationships used in stone disease care.
Intended takeaways include: clarity on what CPT code 50590 represents and where it is performed; the set of primary payers addressed in this analysis; the related procedural coding landscape that commonly accompanies stone management; and the national-level relevance of ESWL in procedural urology. Data not available in the input includes payer-specific reimbursement rates and utilization metrics.
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Billing Code Overview
CPT code 50590 describes extracorporeal shock wave lithotripsy (ESWL), a noninvasive procedure used to fragment calculus (kidney stones) located in the kidneys and ureters. The procedure uses focused shock waves to break stones into smaller pieces that can be passed naturally or removed endoscopically.
Service type: Procedural, therapeutic lithotripsy
Typical site of service: Hospital outpatient department or ambulatory surgical center, with some procedures performed in specialized urology clinics equipped for ESWL.
National Reimbursement Benchmarks
National mean rates cluster with Medicare at $782.20 and BUCA (average commercial) at $3,337.40, indicating Medicare reimbursement sits well below the average commercial level for CPT 50590. The gap of $2,555.20 highlights the persistent spread between federal program pricing and commercial aggregates, with commercial means generally ranging higher than Medicare’s mean.
Dispersion (P75–P25) varies notably across payers: Blue Cross Blue Shield shows a range of $3,504.30, UnitedHealth Group $713.60, Cigna $645.40, Aetna $561.80, and BUCA $2,277.40. Blue Cross Blue Shield therefore exhibits the widest spread, while Aetna is the tightest among payers with full quartile data, suggesting more concentrated pricing for Aetna and greater variability under Blue Cross Blue Shield.