Summary & Overview
CPT 50945: Laparoscopic Ureterolithotomy for Ureteral Stone Removal
CPT code 50945 denotes a laparoscopic ureterolithotomy, a minimally invasive surgical procedure to remove stones from the ureter using a laparoscope. This code is important nationally as an option for management of ureteral calculi when endoscopic or extracorporeal approaches are unsuitable; it affects surgical utilization, facility staffing, and resource planning for urologic services. Major payers that commonly cover this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what this code represents clinically, where the service is typically provided, and the broader policy and billing context that influences its use. The publication summarizes benchmarks and utilization patterns where available, highlights relevant payment and coverage considerations for facility and physician billing, and provides clinical context on indications for laparoscopic ureterolithotomy compared with alternative stone management strategies. Data not available in the input will be noted as such in detailed sections. The content is aimed at billing managers, coding specialists, clinicians, and policy analysts seeking a concise national overview of CPT code 50945 and its implications for practice operations and reimbursement workflows.
Billing Code Overview
CPT code 50945 describes a laparoscopic ureterolithotomy, a surgical procedure in which the provider uses a laparoscope (a thin tube with a camera) to locate and remove a stone from the ureter. The procedure is classified as minimally invasive urologic surgery focused on the extraction of ureteral calculi that are not amenable to less invasive removal techniques.
Service Type: Surgical — Laparoscopic Urologic Procedure
Typical Site of Service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 48-year-old male presents to the emergency department with acute, severe left flank pain, nausea, and hematuria. Imaging (non-contrast CT abdomen/pelvis) demonstrates a 7 mm obstructing calculus in the proximal left ureter with associated hydronephrosis. Conservative measures including hydration, analgesia, and medical expulsive therapy fail, and ureteroscopy is attempted but the stone is not retrievable due to impaction and location. The urology team schedules a laparoscopic ureterolithotomy using a transperitoneal approach under general anesthesia to directly visualize and remove the impacted ureteral stone and repair the ureter if needed.
The clinical workflow includes preoperative evaluation (history, labs, urine culture), informed consent outlining benefits and risks, perioperative antibiotics per protocol, placement of laparoscopic ports, identification of the ureter with laparoscopic camera, ureterotomy and stone extraction, ureteral stent placement as indicated, intraoperative documentation of stone size and location, closure of the ureterotomy, and postoperative monitoring for urine output, pain control, and signs of infection. Typical postoperative follow-up includes stent removal in 2–6 weeks and repeat imaging to confirm ureteral patency and stone clearance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when significant additional work beyond the usual is required (e.g., extensive ureteral reconstruction during ureterolithotomy). |