CPT 52356: Cystourethroscopy with Ureteroscopy, Lithotripsy, and Stent
Medicare pays $370 and commercial payers pay $2258 on average nationally for this procedure.
CPT code 52356 describes a cystourethroscopy with ureteroscopy and/or pyeloscopy performed via a cystoscope passed through the urethra into the bladder to inspect the bladder, urethra, prostatic urethra, and ureteral orifices, with identification and fragmentation of a ureteral or renal pelvic stone using lithotripsy and placement of an indwelling ureteral stent; service type: endoscopic stone management with stent placement; typical site of service: ambulatory surgery center or hospital outpatient setting (endoscopy suite).
For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.
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National Reimbursement Benchmarks
Medicare’s national mean of $370.3 sits well below BUCA’s commercial average of $2,258.30, indicating a substantial gap between public and that commercial benchmark for CPT 52356. The difference of $1,887. (computed as $2,258.30 minus $370.30) underscores that commercial contracts represented by BUCA are paying materially more than Medicare on average for this service.
Dispersion varies meaningfully across payers: Blue Cross Blue Shield shows a tight interquartile spread of $1,425.90 (P75 $3,929.90 minus P25 $2,504.00), while Aetna’s IQR is $485.40 and Cigna’s IQR is $438.70. UnitedHealth Group’s IQR is $468.40. BUCA’s IQR equals $1,011.20 (P75 $2,628.20 minus P25 $1,617.00), making BUCA one of the wider commercial spreads; Blue Cross Blue Shield has the widest IQR of the set, and Cigna the tightest.