CPT 51535 Ureterocele Repair Reimbursement | OpenPayer

Summary & Overview

CPT 51535: Ureterocele Excision or Repair via Bladder Incision

CPT code 51535 identifies a urologic surgical procedure for incision and excision or repair of an ureterocele via an incision in the urinary bladder. This code captures corrective intervention for a congenital dilation of the distal ureter at its bladder insertion and is used across inpatient and outpatient surgical settings. Nationally, accurate coding for this procedure affects claims processing, quality reporting, and payment for urologic services tied to congenital anomalies and obstructive uropathy.

Key payers in this coverage review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers common payment and coding considerations relevant to these payers and summarizes clinical context that supports medical necessity for surgical correction of ureterocele.

Readers will find a concise overview of the clinical procedure and typical sites of service, a summary of payer coverage landscape and common modifiers used in practice, and notes on related billing considerations and documentation that influence payment and claim adjudication. The publication aims to provide clinicians, coding professionals, and policy analysts with clear reference material on CPT code 51535 for coding accuracy and administrative workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 51535ureteroceleurology surgerybladder incisionsurgical codingoperating room proceduresambulatory surgical centercongenital urologic anomaly

Billing Code Overview

CPT code 51535 describes a surgical procedure in which an incision is made into the urinary bladder to excise, incise, or repair an ureterocele, a congenital dilation of the distal ureter at its bladder insertion. The service type is a surgical urologic procedure addressing anatomic obstruction or malformation of the ureterovesical junction. The typical site of service is an operating room or ambulatory surgical center where urologic procedures on the bladder and ureter are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A pediatric or adult patient presents with symptomatic ureterocele identified on ultrasound or cystoscopy after recurrent urinary tract infections, hydronephrosis, or obstructive voiding symptoms. Typical presentation includes febrile urinary tract infection in an infant or child, flank pain and hydronephrosis on renal ultrasound, or incidental finding of a cystic intravesical lesion on imaging. Preoperative evaluation includes renal ultrasound, voiding cystourethrogram (VCUG) if reflux suspected, serum creatinine, and urine culture. The procedure 51535 (incision into the urinary bladder with excision/incision/repair of ureterocele) is performed under general anesthesia in an operating room or ambulatory surgical center. Intraoperative cystoscopy localizes the ureterocele; transvesical incision, excision, or repair is performed to decompress the ureterocele and restore ureteral drainage. Postoperative care includes monitoring urine output, pain control, prophylactic antibiotics as indicated, and follow-up imaging (renal ultrasound and/or VCUG) to assess for persistent obstruction or vesicoureteral reflux. Placement of a ureteral stent or temporary urinary catheter may occur perioperatively based on intraoperative findings and reconstruction complexity.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or time substantially exceeds typical for due to complex reconstruction or extensive dissection.

CPT 51597: Pelvic Exenteration for Bladder, Prostatic, or Urethral Malignancy

CPT-51585-RADICAL-CYSTECTOMY-WITH-URINARY-DIVERSION

CPT 51585: Radical Cystectomy with Urinary Diversion

CPT-51596-RADICAL-CYSTECTOMY-WITH-URINARY-DIVERSION

CPT 51596: Radical Cystectomy With Urinary Diversion

CPT-51575-RADICAL-CYSTECTOMY-PELVIC-LYMPHADENECTOMY

CPT 51575: Radical Cystectomy with Pelvic Lymph Node Dissection

CPT-51590-RADICAL-CYSTECTOMY-WITH-URINARY-DIVERSION

CPT 51590: Radical Cystectomy with Urinary Diversion

CPT-51550-PARTIAL-CYSTECTOMY-SIMPLE-CYSTECTOMY-BLADDER-RESECTION

CPT 51550: Partial (Simple) Cystectomy for Bladder Resection

CPT-51565-BLADDER-RESECTION-AND-URETERAL-REIMPLANTATION

CPT 51565: Bladder Resection with Ureteral Reimplantation

CPT-51530-BLADDER-TUMOR-EXCISION

CPT 51530: Incision for Removal of Bladder Tumor

CPT-51525-BLADDER-DIVERTICULECTOMY-OPEN-EXCISION

CPT 51525: Open Excision of Bladder Diverticulum

CPT-51520-BLADDER-NECK-EXCISION

CPT 51520: Excision of Bladder Neck to Relieve Obstruction

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51535

Taxonomy Code	Specialty	Notes
208000000X	Urology	Most common specialty performing `51535` for ureterocele management.
208800000X	Pediatric Urology	Common for neonatal and pediatric ureterocele repair.
207RI0000X	Pediatric Surgery	May perform in centers where pediatric surgeons manage complex neonatal urinary anomalies.
208D00000X	General Surgery	In some hospitals with urologic collaboration, general surgeons with congenital anomaly experience may participate.
363A00000X	Anesthesiology	Provides anesthesia care for the operative setting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q62.3`	Ureterocele	Primary congenital anomaly addressed by `51535`; reason for incision, excision, or repair.
`N13.2`	Hydronephrosis with ureteral obstruction	Common sequela of ureterocele causing obstructive dilation and indication for repair.
`N39.0`	Urinary tract infection, site not specified	Recurrent UTIs frequently prompt evaluation and treatment of underlying ureterocele.
`N32.9`	Bladder dysfunction, unspecified	May coexist with obstructive lesions and affect postoperative management.
`N13.8`	Other obstructive and reflux uropathy	Related obstructive conditions that can be evaluated and managed during ureterocele repair.
`N30.90`	Cystitis, unspecified, without hematuria	Bladder inflammation that can be associated with ureterocele and affect timing of repair.
`Z00.129`	Encounter for routine child health examination without abnormal findings	May be the context of incidental discovery of ureterocele on screening ultrasound, prompting referral.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, with or without irrigation, instillation, or ureteral catheterization, exclusive of diagnostic cystoscopy	Often performed preoperatively or intraoperatively for visualization and localization of ureterocele prior to `51535`.
`52005`	Cystourethroscopy, with ureteroscopy, with or without irrigation, when performed	Used when ureteroscopy is required to assess ureteral involvement or instrumentation of the ureteral orifice during the ureterocele repair.
`52332`	Cystourethroscopy with fulguration or excision of lesion of bladder (polyp, diverticulum, or other)	May be performed if endoscopic incision/deroofing of ureterocele is done transurethrally as an alternative or adjunct to `51535`.
`52000`	(duplicate)	Data not available in the input.
`52010`	Cystourethroscopy, with insertion of indwelling ureteral catheter(s) (e.g., Fogarty catheter)	May be used to stent or catheterize the ureter intraoperatively to ensure patency after repair.
`50700`	Ureteral reimplantation, reattachment of ureter to bladder (ureteroneocystostomy)	Performed when definitive reconstruction or reimplantation is required in addition to or instead of excision/repair of ureterocele.

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