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    OpenPayerBilling CodesIntroduction Procedures on the BladderCPT cpt-51720-intravesical-instillation-anticarcinogenic-agent
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    CPT 51720: Intravesical Anticarcinogenic Instillation for Bladder Cancer

    Medicare pays $95 and commercial payers pay $332 on average nationally for this procedure.

    CPT code 51720 describes intravesical instillation of an anticarcinogenic agent for bladder cancer, delivered through a urinary catheter and retained in the bladder for a specified dwell time before drainage; this is a procedural treatment service typically performed in an outpatient urology clinic or ambulatory surgical center using short-duration catheter-based bladder instillation techniques.

    For related coverage guidance, see recent payer policy updates: Surgical Procedures, Outpatient Surgical Procedures - Site of Service, Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults.

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    National Reimbursement Benchmarks

    Medicare’s mean rate of $95 sits well below BUCA’s average commercial mean of $331.9, indicating a substantial premium in commercial contracting versus the federal program for CPT 51720. The gap highlights how commercial payers can reimburse multiple times higher than Medicare, with BUCA’s mean approximately $236.9 higher than Medicare’s mean.

    Dispersion varies across payers: Blue Cross Blue Shield shows the widest interquartile spread with P75−P25 = $200. -calculation yields $616.2 − $416.3 = $200.0, while Aetna and UnitedHealth Group exhibit tighter spreads of $59.0 and $85.7 respectively (Aetna: $95.8 − $39.0 = $56.8; UnitedHealth Group: $169.6 − $84.3 = $85.3). Cigna’s IQR is $84.5 ($160.8 − $73.6) and BUCA’s is $147.7 ($413.0 − $265.3). These differences reflect varying pricing consistency across payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a history of non–muscle-invasive bladder cancer presents for intravesical therapy following transurethral resection of bladder tumor (TURBT). The urologist places a sterile urinary catheter in the clinic or ambulatory surgical center, instills an anticarcinogenic agent (e.g., BCG or mitomycin) into the bladder, instructs the patient to retain the instilled solution for the prescribed dwell time (typically 1–2 hours), then drains the agent through the catheter prior to catheter removal. Typical workflow: pre-procedure assessment and informed consent, medication preparation by pharmacy or nursing, catheter insertion and instillation by the urology team, timed dwell in recovery area or outpatient room, drainage and catheter removal, brief post-procedure observation for adverse effects, and documentation of agent, dose, dwell time, and patient tolerance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    51700Bladder irrigation, simple, lavage and/or instillationSimilar technique for instillation or bladder irrigation; may be used for non-oncologic instillations or post-instillation irrigation
    51701Insertion of non-indwelling bladder catheter

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    2088P0231X
    2088F0040X
    172V00000X
    251T00000X
    163WR1000X
    1835C0206X
    2086S0129X

    Related Payer Policy Updates

    Specialty: General Surgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Surgical ProceduresUnitedHealthcare2026-09-01
    Outpatient Surgical Procedures - Site of ServiceUnitedHealthcare2026-09-01
    Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsPremera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Premera Bluecross2026-09-01
    Site of Service Ambulatory Service Center (ASC) SelectPremera Bluecross2026-09-01
    Outpatient Surgical Procedures - Site of Servicesierra health and life2026-08-01
    Medical Necessity Guidelines — Inpatient Surgical CareMass General Brigham Health Plan2026-08-01
    Ambulatory Surgery Center (ASC) - Site of Care PolicyKaiser Permanente2026-08-01

    Related Codes

    CPT-51600-VOIDING-CYSTOURETHROGRAM-VCUG-MCUG

    CPT 51600: Voiding Cystourethrogram (VCUG)

    CPT-51605-URETHROCYSTOGRAPHY-CONTRAST-INSTILLATION-WITH-CHAIN-PLACEMENT

    CPT 51605: Urethrocystography with Contrast and Catheter Insertion

    CPT-51610-URETHROCYSTOGRAPHY-URETHRA-BLADDER-CONTRAST-STUDY

    CPT 51610: Urethrocystography with Retrograde Contrast

    CPT-51700-BLADDER-IRRIGATION-INSTILLATION

    CPT 51700: Bladder Instillation and Irrigation via Catheter

    CPT-51701-INTERMITTENT-URINARY-CATHETERIZATION-RESIDUAL-URINE

    CPT 51701: Intermittent Urethral Catheterization, Non‑Indwelling

    CPT-51702-BLADDER-CATHETERIZATION-PLACEMENT-MANAGEMENT

    CPT 51702: Non‑indwelling Bladder Catheterization

    CPT-51703-BLADDER-CATHETERIZATION-PROCEDURE

    CPT 51703: Indwelling Bladder Catheter Insertion

    CPT-51705-BLADDER-TUBE-REPLACEMENT-SIMPLE-EXCHANGE

    CPT 51705: Simple Removal and Replacement of Bladder Tube

    CPT-51710-COMPLICATED-BLADDER-CATHETER-REPLACEMENT

    CPT 51710: Replacement of Indwelling Bladder Tube, Complicated

    CPT-51715-ENDOSCOPIC-URETHRAL-BLADDER-NECK-INJECTION-INCONTINENCE

    CPT 51715: Endoscopic Urethral/Bladder Neck Bulking Injection

    Showing 1–10 of 11

    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.
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    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.

    Often performed immediately prior to instillation when a temporary non-indwelling catheter is used for drug instillation
    51702Insertion of temporary indwelling bladder catheterUsed when an indwelling catheter is placed for dwell and drainage of instilled agent
    51703Insertion of temporary indwelling bladder catheter; complicatedCoded when catheter placement is technically difficult before instillation
    51725Simple cystometrogram (CMG)Performed in separate urodynamic evaluation; not typically same-day with 51720 but related to bladder function assessment
    51726Complex cystometrogram (CMG) with urethral pressure profile studiesAdvanced urodynamic testing related to bladder dysfunction evaluation and may be part of the broader urologic care plan