Summary & Overview
CPT 50961: Percutaneous Endoscopic Kidney/Ureter Examination and Stone Removal
CPT code 50961 represents a percutaneous endoscopic examination of the kidney, renal pelvis, and ureter performed through an existing skin-to-ureter tract, commonly used for removal of ureteral or renal stones and foreign bodies. This code is significant nationally because it captures a specialized, operative endoscopic service that involves percutaneous access and management of urolithiasis — a high-volume clinical condition with implications for surgical services, facility utilization, and payer coverage policies.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure type and typical sites of service, along with benchmarks and policy-relevant information where available. The publication summarizes coding intent, common use cases, and payer coverage considerations to help stakeholders understand how CPT code 50961 is applied across settings. Where input data are incomplete, specific benchmarking elements are noted as not available. The content is nationally focused and intended for clinicians, coding professionals, and policy analysts seeking a concise reference to this procedural code.
Billing Code Overview
CPT code 50961 describes an endoscopic examination of the kidney, renal pelvis, and ureter performed through an existing percutaneous access tract. The procedure is typically performed to locate and remove ureteral or renal stones and other foreign bodies using an endoscope advanced through an opening already established between the skin and ureter.
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Service type: Percutaneous endoscopic renal/ureteral procedure for stone or foreign body removal
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Typical site of service: Hospital operating room or ambulatory surgical center where percutaneous access and endoscopic removal can be performed
Clinical & Coding Specifications
Clinical Context
A 46-year-old male with a history of recurrent nephrolithiasis presents with acute onset right flank pain, hematuria, and nausea. Non-contrast CT confirms a 7 mm obstructing stone in the proximal right ureter with hydronephrosis and persistent symptoms despite medical management. The urology team schedules a ureteroscopy through an established percutaneous nephrostomy tract to evaluate and remove the ureteral stone and inspect the renal pelvis and ureter. In the operating room the patient undergoes anesthesia, cystoscopy to access the collecting system via the existing percutaneous tract, and endoscopic inspection of the renal pelvis and ureter. Stone extraction is performed with graspers and/or laser lithotripsy, fragments are retrieved, and a ureteral stent may be placed at the conclusion. Typical documentation includes indication, prior established skin-to-ureter access, findings, devices used, estimated blood loss, complications (if any), and post-op plan for stent management and follow-up imaging.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | Use when another unrelated procedure is performed in a separate anatomic site or session and documentation supports distinct procedural work. |
62 |