Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesVesical Neck and Prostate Surgical ProceduresCPT cpt-52500-cystourethroscopy-transurethral-excision-bladder-neck
    Ask Trek AI about this page

    CPT 52500: Transurethral Excision of Bladder Neck to Relieve Obstruction

    Medicare pays $360 and commercial payers pay $1975 on average nationally for this procedure.

    CPT code 52500 describes a transurethral cystourethroscopy with excision of bladder neck tissue to relieve urinary outlet obstruction; this is an endoscopic surgical procedure performed via the urethra using a cystourethroscope and typically provided in an operating room or procedure suite as a urologic surgical service to address bladder-neck obstruction and related obstructive lower urinary tract conditions.

    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.

    Customize your policy alerts

    Sign up for cpt 52500 policy alerts

    Get alerted when payer policies referencing 52500 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Medicare’s mean rate for CPT 52500 is $360.20, which sits well below BUCA’s average commercial mean of $1,975.00, illustrating a substantial gap between public program reimbursement and the aggregated commercial benchmark represented by BUCA. Blue Cross Blue Shield and UnitedHealth Group have mean rates closer to BUCA ($2,945.20 and $872.50 respectively), while Aetna and Cigna remain nearer to Medicare’s level; this frames Medicare as the low anchor and BUCA as the high commercial benchmark for national reimbursement expectations.

    Rate dispersion measured as the interquartile spread (P75 minus P25) highlights considerable variability across payers. Blue Cross Blue Shield has the widest IQR at $3,210.00 ($4,187.30 - $977.30), followed by UnitedHealth Group at $522.10 ($1,078.10 - $546.50). The tightest spreads appear with Medicare at $27.00 ($371 - $344) and Aetna at $430.00 ($507.90 - $79.00), indicating more consistency for those payers relative to the broader commercial market.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male presents to urology clinic with progressive urinary frequency, weak stream, nocturia, and incomplete bladder emptying despite medical therapy for benign prostatic hyperplasia. On history and uroflowmetry there is a post-void residual elevated and bladder outlet obstruction suspected. The urologist performs cystourethroscopy in the ambulatory surgery center: a cystourethroscope is passed through the urethra to inspect the urethra and bladder, then advanced to the bladder neck where transurethral excision of obstructing tissue at the bladder neck is performed to relieve the obstruction. The procedure is typically scheduled after office evaluation and preoperative clearance, performed under regional or general anesthesia, with intraoperative endoscopic visualization, possible tissue excision and hemostasis, and same-day recovery and discharge with short-term catheterization as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    52640Relieve bladder contractureMay be performed for bladder neck contracture or adjunctive endoscopic release when bladder neck scarring contributes to obstruction

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    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…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    2088P0231X
    2088F0040X
    171WH0202X
    221700000X
    373H00000X
    291900000X
    251T00000X

    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-52402-EJACULATORY-DUCT-ENDOSCOPIC-EXCISION-OR-INCISION

    CPT 52402: Cystoscopic Excision or Incision of Ejaculatory Duct

    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-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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Rate by payer