Summary & Overview

CPT 50976: Ureteroscopic Examination with Biopsy and Fulguration

CPT code 50976 represents an endoscopic urologic procedure that involves incising the ureter, passing an endoscope to inspect the kidneys, renal pelvis, and ureters, and performing a biopsy with possible tissue destruction such as fulguration. Nationally, this code captures diagnostic evaluation and targeted intervention for upper urinary tract lesions and is relevant for hospital, ambulatory surgical center, and inpatient billing workflows. Key payers commonly analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication provides a concise national overview of clinical context, billing considerations, and benchmarking content for 50976. Readers will find: concise clinical description and typical sites of service; a summary of common modifiers and billing considerations where available; benchmark and coverage highlights for major public and commercial payers; and context to support revenue cycle and compliance teams in coding and claim submission. Data not available in the input for specific payor coverage rules, reimbursement rates, and ICD-10 pairings are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare50976CPTureteroscopyurologybiopsyfulgurationendoscopyoperating-roomambulatory-surgery-center

Billing Code Overview

CPT code 50976 describes a diagnostic and interventional endoscopic procedure in which the provider incises the ureter and passes an endoscope to examine the kidneys, renal pelvis, and ureters. The procedure explicitly includes biopsy of a lesion or tissue and may incorporate visualization techniques, fulguration (high-frequency heat), or incision to destroy tissue.

Service type: Endoscopic urologic procedure with biopsy and possible tissue destruction

Typical site of service: Operating room or ambulatory surgical center; may also occur in inpatient hospital settings depending on clinical need and patient status.

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with gross hematuria and recurrent flank pain is referred to urology after CT imaging suggests a filling defect in the renal pelvis. The patient is scheduled for ureteroscopy with renal pelvic inspection and biopsy. In the preoperative workflow the patient undergoes consent, anesthesia evaluation (general or regional), and pre-op antibiotics per institutional protocol. In the operating room the surgeon performs cystoscopy to identify the ureteral orifice, incises the ureteral orifice or uses a ureteral access sheath as needed, advances a flexible ureteroscope up the ureter into the renal pelvis to directly visualize a lesion, obtains cold forceps or brush biopsy specimens, and performs fulguration or holmium laser ablation of small papillary tumors if indicated. A ureteral stent may be placed for drainage post-procedure. Immediate postoperative steps include recovery, pain control, discharge instructions, and follow-up for pathology results and stent removal if placed. Typical site of service is an ambulatory surgery center or hospital outpatient department. Service type is minimally invasive endoscopic diagnostic and operative urologic procedure.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional interpretation/management separate from technical services.
`51`	Multiple procedures	Use when more than one distinct procedure is performed during the same session and payer rules require modifier for multiple procedures.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use if procedure is started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons from different specialties perform distinct portions of the procedure.
`66`	Surgical team	Use when a surgical team approach is documented for a complex procedure.
`78`	Unplanned return to OR for related procedure during postoperative period	Use when patient returns to operating room for procedure related to the original ureteroscopy during the global period.
`80`	Assistant surgeon	Use when an assistant surgeon actively assists during the procedure and documentation supports assistant billing.
`81`	Minimum assistant surgeon	Use when minimal assistance is documented and payer accepts this modifier.
`52`	Reduced services	Use when procedure is performed but with significantly reduced effort or extent.
`73`	Discontinued outpatient hospital/ASC procedure prior to anesthesia administration	Use if the outpatient procedure is cancelled after patient arrival but before anesthesia.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when another physician repeats the procedure later the same day.
`TC`	Technical component	Use when billing only the technical component (facility/equipment) separate from the professional service.

Taxonomy Code	Specialty	Notes
2080P0208X	Urology	Primary specialty performing ureteroscopy and renal pelvic/ureteral endoscopy.
208000000X	Urology - Clinical	Common provider taxonomy for practicing urologists in clinical settings.
207L00000X	General Surgery	Some general surgeons with endourology training may perform urologic endoscopic procedures in select settings.
2084P0800X	Pediatric Urology	Performs ureteroscopy and related procedures in pediatric patients when indicated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C67.9`	Malignant neoplasm of bladder, unspecified	Hematuria and bladder lesions may prompt endoscopic evaluation and mapping including ureteroscopy if upper tract involvement suspected.
`N20.1`	Calculus of ureter	Ureteroscopy is commonly used to visualize and treat ureteral stones with fragmentation or extraction.
`N13.6`	Pyelovenous/pyelolymphatic reflux	Anatomic or obstructive issues visualized during ureteroscopy; procedure can assist diagnosis or intervention.
`N13.9`	Obstruction of ureter, unspecified	Ureteroscopy is used to evaluate and sometimes relieve ureteral obstruction and obtain biopsy if mass suspected.
`R31.9`	Hematuria, unspecified	Common presenting symptom leading to diagnostic ureteroscopy and pelvic/ureteral inspection with biopsy capability.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystoscopy, with or without collection of specimen(s) by brushing or washing (separate procedure)	Often performed immediately before ureteroscopy to inspect the bladder and identify ureteral orifices.
`52332`	Cystoureteroscopy, with ureteroscopy and/or pyeloscopy; with biopsy, single or multiple	Overlapping code for ureteroscopic biopsy of ureteral or renal pelvic lesions; used for similar diagnostic sampling in the ureter.
`52356`	Cystoureteroscopy, with laser lithotripsy of ureteral stone(s)	Performed when ureteroscopic visualization also identifies and treats stones using laser energy during the same session.
`52353`	Cystoureteroscopy, with ureteroscopy; with removal of ureteral calculus by lithotripsy	Related when stone extraction/lithotripsy is required during ureteroscopy.
`52310`	Cystoureteroscopy, with diagnostic, with or without ureteral catheterization, with or without removal of ureteral stent	May be used for diagnostic ureteroscopy or stent-related procedures performed before or after definitive ureteroscopy.