Summary & Overview
CPT 50974: Ureteroscopy of Kidney, Renal Pelvis, Ureters with Biopsy
CPT code 50974 describes ureteroscopic exploration of the kidney, renal pelvis, and ureters via incision of the ureter with endoscopic passage and tissue biopsy, typically performed as part of ureteral stone removal. Nationally, this code captures a targeted endourologic procedure used in both inpatient and outpatient surgical settings and is relevant for clinicians, hospitals, and payers managing care for patients with obstructing or symptomatic ureteral calculi.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines clinical context, common service locations, and the primary use-case of the procedure—diagnosis and management of ureteral stones with concomitant tissue sampling.
Readers will learn how the procedure is described clinically and operationally, which payers are commonly involved, and what to expect in terms of service setting and clinical intent. The report provides benchmarks and policy-relevant context where data are available, notes areas where information was not provided, and summarizes implications for coding and billing workflows tied to endoscopic stone management and biopsy.
Billing Code Overview
CPT code 50974 describes an endoscopic examination of the kidney, renal pelvis, and ureters performed by incising the ureter and passing an endoscope to visualize those structures. The procedure includes biopsy of tissue and is performed in the context of removing ureteral stones.
Service Type: Endoscopic genitourinary procedure with biopsy for stone management
Typical Site of Service: Operating room or procedure suite; inpatient or outpatient surgical setting
Clinical & Coding Specifications
Clinical Context
A 52-year-old female presents to the emergency department with acute right flank pain, nausea, and hematuria. CT scan of the abdomen and pelvis with renal stone protocol demonstrates a 7 mm obstructing mid-ureteral calculus with hydronephrosis and persistent pain despite medical therapy. After urology consultation, the patient is scheduled for ureteroscopy with ureteral incision and endoscopic evaluation, stone extraction, and tissue biopsy of an abnormal ureteral lesion noted during endoscopic inspection. The procedure is performed in an operating room under general anesthesia. The clinical workflow includes preoperative evaluation and consent, intraoperative cystoscopic access, ureteral incision and passage of a ureteroscope into the ureter and renal pelvis, endoscopic visualization and biopsy of suspicious tissue, stone extraction with basket or laser lithotripsy as indicated, possible placement of a ureteral stent for drainage, documentation of findings and specimens, and postoperative recovery with discharge instructions and pathology follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or routine service | Use when the procedure is the primary and performed as planned without complications |
22 |