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    v1.0.30
    OpenPayerBilling CodesVesical Neck and Prostate Surgical ProceduresCPT cpt-52402-ejaculatory-duct-endoscopic-excision-or-incision
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    CPT 52402: Cystoscopic Excision or Incision of Ejaculatory Duct

    Medicare pays $234 and commercial payers pay $1767 on average nationally for this procedure.

    CPT code 52402 describes cystoscopic inspection of the ejaculatory ducts with excision or incision to remove an obstruction or open a stricture; this is a diagnostic and surgical endoscopic urologic procedure typically performed in an operating room or ambulatory surgery center under anesthesia using a cystoscope passed through the urethra.

    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 for CPT 52402 sits at $233.90, while BUCA’s average commercial mean is substantially higher at $1,766.70, indicating that commercial negotiated levels can exceed Medicare by roughly $1,532.80 on average. This gap underscores a pronounced split between government reimbursement and the broader commercial market for this procedure.

    Dispersion varies markedly across payers. Blue Cross Blue Shield has the widest interquartile spread (P75–P25 = $3,335.30), followed by BUCA at $1,900.20 and UnitedHealth Group at $295.50. Aetna and Cigna show the tightest spreads at $93.00 and $286.00 respectively, indicating more clustered commercial pricing for those payers compared with the larger variability seen with Blue Cross Blue Shield and BUCA.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old male presents to a urology clinic with recurrent painful ejaculation, ejaculatory obstruction, and decreased semen volume. Prior evaluation with imaging and semen analysis suggests obstruction of the ejaculatory ducts possibly related to a small obstructing calculus or stricture. The patient is scheduled for transurethral cystoscopic evaluation under monitored anesthesia care or general anesthesia. In the procedure suite, a urologist introduces a rigid or flexible cystoscope through the urethra to visually inspect the prostatic urethra and identify the ejaculatory duct orifices. When a focal obstructive lesion is identified, the surgeon performs transurethral excision of the obstructed duct segment or makes a precise incision (ductotomy) to relieve a stricture and restore patency. Specimens or stone fragments may be retrieved for pathology or analysis. Typical perioperative workflow includes preoperative assessment, informed consent, anesthesia induction, cystoscopic procedure with possible concurrent bladder inspection for associated calculi, hemostasis, and post-anesthesia recovery. Typical site of service is an ambulatory surgery center or hospital operating room staffed by urology providers, with postoperative follow-up in clinic for symptom assessment and potential imaging or semen analysis.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36000Introduction of needle or intracatheter, veinMay be used for IV access for sedation or anesthesia during the cystoscopic procedure

    Related Modifiers

    12 rows

    ModifierDescriptionWhen to Use
    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…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    2088P0231X
    2088F0040X
    2279G0305X
    2086S0122X
    207VH0002X
    163WG0100X
    207UN0902X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    N20.0Calculus of kidney
    N20.1Calculus of ureter
    N20.9Urinary calculus, unspecified
    N21.0Calculus in bladder
    N21.1Calculus in urethra
    N41.0Acute prostatitis
    N41.1Chronic prostatitis
    N41.2Abscess of prostate
    N41.3Prostatocystitis
    N41.9Inflammatory disease of prostate, unspecified

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    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-52400-CYSTOURETHROSCOPY-CYSTOSCOPE-BLADDER-INSPECTION

    CPT 52400: Diagnostic Cystourethroscopy

    CPT-52441-TRANSPROSTATIC-IMPLANT-PLACEMENT-CYSTOURETHROSCOPIC

    CPT 52441: Single Permanent Adjustable Transprostatic Implant

    CPT-52442-TRANSPROSTATIC-IMPLANT-ADD-ON-PLACEMENT

    CPT 52442: Placement of Additional Permanent Adjustable Transprostatic Implant

    CPT-52443-BALLOON-DILATION-AND-DRUG-COATED-BALLOON-PROSTATE

    CPT 52443: Cystoscopic Transurethral Prostate Drug Delivery

    CPT-52450-TRANSURETHRAL-PROSTATE-CAPSULOTOMY-ENDOSCOPIC-INCISION

    CPT 52450: Endoscopic Transurethral Prostate Capsulotomy

    CPT-52500-CYSTOURETHROSCOPY-TRANSURETHRAL-EXCISION-BLADDER-NECK

    CPT 52500: Transurethral Excision of Bladder Neck to Relieve Obstruction

    CPT-52597-ROBOTIC-WATERJET-PROSTATE-TISSUE-REMOVAL-THROUGH-URETHRA

    CPT 52597: Robotic Transurethral Waterjet Prostate Resection

    CPT-52601-TRANSURETHRAL-RESECTION-PROSTATE-TURP

    CPT 52601: Transurethral Resection of Prostate (Partial)

    CPT-52630-PROSTATE-RESECTION-RESIDUAL-TISSUE

    CPT 52630: Resection of Residual or Regrown Prostate Tissue

    CPT-52640-ENDOSCOPIC-REMOVAL-BLADDER-NECK-CONTRACTURE

    CPT 52640: Endoscopic Removal of Postoperative Bladder Neck Contracture

    Showing 1–10 of 13

    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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    36410Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure)May be billed when venipuncture is performed by the physician for access when nursing phlebotomy is not performed; typically relates to anesthetic or therapeutic access