Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesEndoscopy Procedures on the UreterCPT cpt-50970-ureteroscopic-examination-and-stone-removal
    Ask Trek AI about this page

    CPT 50970: Ureteroscopy with Ureterotomy for Ureteral Stone Removal

    Medicare pays $330 on average nationally for this procedure.

    CPT code 50970 describes an operative ureteroscopy with ureterotomy in which the provider incises the ureter and advances an endoscope to examine the kidney, renal pelvis, and ureters and employs visualization techniques to locate and remove ureteral stones; service type: endoscopic urologic stone removal, typical site of service: operating room or procedure suite in an ambulatory surgical center or hospital.

    For related coverage guidance, see recent payer policy updates: Diabetic Supplies, Radiofrequency Ablation for Thyroid Nodules, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only).

    Customize your policy alerts

    Sign up for cpt 50970 policy alerts

    Get alerted when payer policies referencing 50970 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 48-year-old patient presents to the urology clinic with acute-onset right flank pain, hematuria, and nausea. Non-contrast CT confirms a 7 mm obstructing ureteral stone in the proximal right ureter with associated hydronephrosis and renal colic. Conservative measures, including analgesia and medical expulsive therapy, fail and the patient is scheduled for ureteroscopy with stone removal.

    Preoperative evaluation includes history and physical, review of imaging, urine culture, and informed consent. The procedure is performed in an outpatient ambulatory surgery center or hospital operating room under general or regional anesthesia. The urologist cystoscopically accesses the ureter, performs a ureterotomy or passes a ureteroscope through the ureteral orifice, inspects the ureter, renal pelvis, and calyces, uses visualization techniques such as irrigation, fluoroscopic guidance, stone fragmentation devices (laser lithotripsy), and basket retrieval for extraction of stone fragments. A ureteral stent may be placed at the conclusion for ureteral drainage. Postoperative workflow includes recovery in PACU, analgesia, discharge instructions, and arrangements for stent removal if placed.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    52351Cystoureteroscopy, with ureteroscopy and/or pyeloscopy; diagnostic, with or without collection of specimensPerformed when diagnostic evaluation of the ureter and renal pelvis is required prior to or during stone management; may be billed for diagnostic-only ureteroscopic evaluation.
    52352Cystoureteroscopy, with ureteroscopy and/or pyeloscopy; with treatment of ureteral stone by ureteroscopy, including lithotripsy and removalOften billed for ureteroscopic treatment of ureteral stones; may overlap with 50970 depending on payer definitions—verify local payer coding rules.
    50590Lithotripsy, extracorporeal shock wave (ESWL)Alternative or adjunct treatment for renal or proximal ureteral stones; may be used before or after ureteroscopy depending on clinical scenario.
    52332Cystoureteroscopy, with removal of ureteral calculus; with ureteroscopy and/or pyeloscopy, including intraluminal maneuversUsed for endoscopic removal of ureteral stones; commonly performed in the same clinical workflow as ureteroscopic stone extraction.
    51020Ureteral catheterization, retrograde, not requiring cystoscopy with anesthesiaAncillary procedure for retrograde pyelography or drainage during endoscopic evaluation; may be used adjunctively during ureteroscopy.

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    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…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    2080P0207X
    207L00000X
    2086S0122X
    163WN0300X
    261QA0600X
    2279E1000X
    363LP0222X

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    10 rows

    PolicyPayerEffective Date
    Diabetic SuppliesCigna2026-10-15
    Radiofrequency Ablation for Thyroid NodulesCigna2026-10-15
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only)UnitedHealthcare2026-10-01
    Tzield (teplizumab-mzwv) CoverageUnitedHealthcare2026-10-01
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Indiana Only)UnitedHealthcare2026-10-01
    Medical Necessity Guidelines Insulin PumpsMass General Brigham Health Plan2026-10-01
    Medical Necessity Guidelines: Continuous Glucose MonitorsMass General Brigham Health Plan2026-10-01
    Continuous Glucose MonitoringAmbetter Nevada2026-10-01
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01

    Related Codes

    CPT-50951-PERCUTANEOUS-URETEROSCOPY-URETERAL-STONE-REMOVAL

    CPT 50951: Percutaneous Nephroscopy/Ureteroscopy for Stone Evaluation and Removal

    CPT-50953-PERCUTANEOUS-URETEROSCOPIC-EXAMINATION-CATHETERIZATION

    CPT 50953: Endoscopic Exam via Cutaneous Ureteral Tract

    CPT-50955-ENDOSCOPIC-URETERAL-BIOPSY-VIA-ESTABLISHED-TRACT

    CPT 50955: Endoscopic Biopsy of Ureter via Established Tract

    CPT-50957-PERCUTANEOUS-ENDOSCOPIC-RENAL-URETEROSCOPIC-PROCEDURE-MALIGNANCY

    CPT 50957: Endoscopic Exam via Cutaneous Ureterostomy for Biopsy/Destruction

    CPT-50961-PERCUTANEOUS-ENDOSCOPIC-URETERAL-STONE-REMOVAL

    CPT 50961: Percutaneous Ureteroscopy via Existing Skin-Ureter Tract

    CPT-50972-URETEROSCOPY-URETEROTOMY-FOR-STONE-REMOVAL

    CPT 50972: Ureteroscopy with Ureteral Endoscopy for Stone Removal

    CPT-50974-URETEROSCOPIC-KIDNEY-RENAL-PELVIS-URETER-BIOPSY-STONE-REMOVAL

    CPT 50974: Ureteroscopy with Biopsy and Ureteral Stone Removal

    CPT-50976-URETEROSCOPIC-EXAMINATION-BIOPSY-FULGURATION

    CPT 50976: Ureteroscopy with Biopsy and Tissue Destruction

    CPT-50980-URETEROSCOPY-WITH-URETEROTOMY-AND-STONE-REMOVAL

    CPT 50980: Ureteroscopy with Inspection and Stone Removal

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.