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CPT 52402: Cystoscopic Excision or Incision of Ejaculatory Duct
CPT code 52402 covers cystoscopic inspection and surgical treatment of the ejaculatory ducts, including excision of obstructed segments or incision of strictures. This code captures a targeted endoscopic procedure performed by urologists to address obstruction of the ejaculatory ducts that can affect semen passage and related urologic symptoms. Nationally, accurate coding for this procedure matters for clinical documentation, surgical case mix reporting, and appropriate payment for specialized endoscopic urologic services.
Key payers referenced in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find concise information on the clinical context of the procedure, typical sites of service (ambulatory surgical center or hospital operating room), and how the code maps to urology specialty practice. The publication provides benchmarking context, payer coverage considerations, and coding relationships that influence billing and claim adjudication for this service.
The content is useful for coding and revenue cycle staff, practice managers in urology, and payers seeking clarity on the procedural definition and clinical intent behind CPT code 52402. Data not available in the input where applicable is noted.
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Billing Code Overview
CPT code 52402 describes an endoscopic urologic procedure in which a cystoscope is passed through the urethra to inspect the ejaculatory ducts and either excise an obstructed segment or incise a stricture to restore patency.
Service type: Endoscopic ejaculatory duct procedure (diagnostic with therapeutic incision or excision).
Typical site of service: Ambulatory surgical center or hospital operating room where cystoscopic urologic procedures are performed.
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.