Summary & Overview
CPT 52250: Cystoscopic Intravesical Radioactive Therapy for Bladder Cancer
CPT code 52250 denotes cystoscopic delivery of a radioactive agent into the bladder to treat bladder cancer, performed with direct endoscopic visualization and potential biopsy or fulguration of suspicious lesions. Nationally, this code captures a specialized urologic oncology procedure used for intravesical radiation therapy as part of bladder-sparing management strategies. Accurate coding supports appropriate tracking of oncologic care, reimbursement for facility and professional components, and quality measurement for bladder cancer interventions.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise reference to how this procedure is described clinically, typical sites of service, and common modifiers that may appear on claims. Readers will find benchmarks and coding context relevant to billing and revenue cycle operations, a summary of clinical indications tied to bladder malignancy, and notes on documentation elements commonly needed to support medical necessity.
This material is intended for coding professionals, revenue cycle staff, and clinical leaders seeking a clear, national-level overview of CPT code 52250, its clinical role in bladder cancer care, and the coding considerations that affect claim processing and policy alignment.
Billing Code Overview
CPT code 52250 describes cystoscopic instillation of a radioactive therapeutic agent into the bladder. The procedure involves passing a cystoscope through the urethra to inspect the urethra, prostatic urethra (in men), bladder interior, and ureteric orifices, and then delivering a radioactive substance directly into the bladder to treat malignancy. The provider may also fulgurate suspicious lesions or obtain biopsy samples during the same cystoscopic evaluation.
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Service type: Outpatient endoscopic bladder procedure with intravesical radioactive therapy
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also occur in urology clinic procedure suites
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with a history of high-grade non–muscle-invasive bladder cancer presents for intravesical radioactive isotope therapy delivered via cystoscope. The patient arrives to an ambulatory surgical center after preoperative evaluation including urinalysis and medication reconciliation. Under monitored anesthesia care or general anesthesia provided by the anesthesiologist, the urologist performs a diagnostic cystoscopy using a rigid or flexible cystoscope passed through the urethra to inspect the urethra, prostatic urethra, bladder interior, and ureteric orifices. After visual inspection, the provider instills a radioactive therapeutic agent into the bladder through the cystoscope delivery system to treat localized tumor burden; the provider may also fulgurate suspicious lesions or obtain cold cup or biopsy samples for pathology if indicated. Hemostasis is confirmed, the bladder is irrigated, and the patient is recovered in the PACU with voiding instructions and follow-up arranged with the treating urologist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or more than usual service | Use when the service represents the usual, uncomplicated performance of the procedure. |
22 |