Summary & Overview

CPT 52355: Cystourethroscopy with Ureteroscopic/Pyeloscopic Tumor Resection

CPT code 52355 covers cystourethroscopy combined with ureteroscopy and/or pyeloscopy when a ureteral or pelvic tumor is identified and resected. This code represents a definitive endoscopic diagnostic and therapeutic urologic procedure used to visualize the lower urinary tract and resect intraluminal tumors of the ureter or renal pelvis. Nationally, the code is relevant for hospitals and ambulatory surgical centers that provide endourologic oncologic care and for payers managing coverage for urologic tumor interventions.

Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and site of care, paired with coverage and billing considerations typically relevant to these payers. The publication also outlines benchmarking and policy context where available, clarifies coding intent for clinical documentation, and identifies common operational touchpoints for claims submission and utilization review.

This national overview is intended to help billing managers, coding professionals, and health policy staff understand the clinical scope of CPT code 52355, its place in urologic procedural coding, and the typical payer landscape for endoscopic ureteral/pelvic tumor resections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare52355CPTurologycystourethroscopyureteroscopypyeloscopyendourologytumor resectionsurgical-procedures

Billing Code Overview

CPT code 52355 describes a surgical endoscopic procedure in which a provider performs a cystourethroscopy (inspection of the bladder, urethra, prostatic urethra, and ureteric orifices) and a ureteroscopy and/or pyeloscopy (inspection of the ureters and renal pelvis). During the procedure the clinician identifies a tumor in the ureter or renal pelvis and performs resection of that tumor.

Service type: Endoscopic urologic tumor resection (diagnostic cystourethroscopy with therapeutic ureteroscopic/pyeloscopic tumor resection)
Typical site of service: Hospital operating room or ambulatory surgical center, with cystoscopic and ureteroscopic instrumentation passed through the urethra into the bladder and up the ureter to the renal pelvis.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents with painless gross hematuria and intermittent flank pain. Imaging (CT urogram) demonstrates a filling defect in the distal ureter concerning for a ureteral tumor. The urologist schedules the patient for a diagnostic cystourethroscopy with ureteroscopy and planned endoscopic resection of the ureteral lesion. In the preoperative workflow, the patient undergoes urine culture and coagulation assessment; informed consent is obtained for cystoscopy, ureteroscopy, possible tumor resection, and stent placement. In the operating room or endoscopy suite under general or spinal anesthesia, a cystoscope is advanced via the urethra to inspect the urethra, prostatic urethra, and bladder. The ureteral orifice is identified, and a ureteroscope or flexible nephroscope is passed into the ureter and renal pelvis (pyeloscopy as needed). The lesion is visualized and resected or fulgurated endoscopically; tissue is sent for pathology. A ureteral stent may be placed for drainage. Postoperative workflow includes recovery, pathology review, and surveillance planning (imaging and cystoscopic follow-up). Typical site of service is an ambulatory surgery center or hospital outpatient department; inpatient admission may occur for complications or if combined with more extensive procedures. Service type: endoscopic urologic diagnostic and operative procedure (cystourethroscopy with ureteroscopy/pyeloscopy and tumor resection).

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure	Use if a documented evaluation and management visit above the usual preoperative visit is provided on the same day as the cystoscopy/ureteroscopy.
`26`	Professional component	Use when reporting only the physician's professional component separate from technical services (rare for this full procedure).
`50`	Bilateral procedure	Use if identical procedures are performed bilaterally and payer accepts bilateral modifier for endoscopic resections (uncommon for unilateral ureteral tumor).
`52`	Reduced services	Use when the procedure was partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use if the procedure was started but terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Unplanned return to the operating/procedure room for a related procedure during the global period	Use if patient returns to the OR for a complication related to the index procedure during the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use if an unrelated procedure is performed during the global period (note: `79` is not in provided list; not selected).
`80`	Assistant surgeon	Use when an assistant surgeon participates and payer recognizes an assistant surgeon for this endoscopic procedure.
`52`	Reduced services	Duplicate entry avoided; only list once.

Taxonomy Code	Specialty	Notes
`2080P0206X`	Urology	Urologists most commonly perform cystourethroscopy with ureteroscopy and tumor resection.
`208D00000X`	Urology - Pediatric (if applicable)	Pediatric urologists perform similar endoscopic procedures in children when indicated.
`207T00000X`	General Surgery	General surgeons with endourology training may perform select endoscopic urologic procedures in some settings.
`208600000X`	Surgical Oncology	Genitourinary surgical oncologists manage ureteral or renal pelvic tumors and perform endoscopic resections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`52000`	Cystourethroscopy, diagnostic, with or without collection of specimen(s) by brushing or washing	Performed when a diagnostic cystoscopy is done without ureteroscopy; often precedes or complements `52355` for bladder evaluation.
`53040`	Ureteroscopy, with or without irrigation, simple	May be billed for diagnostic ureteroscopy without tumor resection; used when ureteroscopy is performed without endoscopic tumor removal.
`52356`	Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with removal of ureteral stone(s) by ureteroscopy (with or without lithotripsy)	Performed when ureteroscopy is used to remove stones rather than resect a tumor; alternative obstructive lesion management.
`50380`	Endoscopic resection of renal pelvic tumor (if applicable)	Represents endoscopic management of a renal pelvic tumor; used when tumor is in pelvis and resected endoscopically.
`52204`	Cystourethroscopy with fulguration or resection of solid or papillary tumor of the bladder; single or multiple	If a concurrent bladder tumor is resected during the same session, this code describes bladder tumor resection and may be reported in addition to ureteral tumor resection when documentation supports multiple distinct anatomic sites.