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    v1.0.28
    OpenPayerBilling CodesVesical Neck and Prostate Surgical ProceduresCPT cpt-52649-holmium-laser-enucleation-prostate-holep-morcellation
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    CPT 52649: Holmium Laser Enucleation of Prostate with Morcellation

    Medicare pays $669 on average nationally for this procedure.

    CPT code 52649 describes transurethral holmium laser enucleation of the prostate (HoLEP) with mechanical morcellation for treatment of benign prostatic hyperplasia (BPH); this operative endoscopic prostate enucleation procedure is performed to remove obstructing prostatic tissue and relieve lower urinary tract symptoms, is a surgical/operative service, and is typically performed in an outpatient ambulatory surgery center or hospital operating room under appropriate anesthesia.

    For related coverage guidance, see recent payer policy updates: Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults, Site of Service Ambulatory Service Center (ASC) Select.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old man with progressive lower urinary tract symptoms (urinary frequency, nocturia, weak stream, and sensation of incomplete emptying) refractory to medical therapy presents for surgical management of benign prostatic hyperplasia (BPH). Preoperative evaluation includes history and physical, urinalysis to exclude infection, PSA and prostate imaging or transrectal ultrasound to estimate prostate volume. The patient is scheduled for holmium laser enucleation of the prostate (HoLEP) with mechanical morcellation under general or spinal anesthesia in an ambulatory surgery center or hospital operating room. Intraoperative steps include cystoscopic assessment, holmium:YAG laser enucleation of prostatic adenoma into the bladder, followed by mechanical morcellation and retrieval of enucleated tissue fragments. Postoperative care includes short-term catheterization, monitoring for hematuria and urinary retention, pain control, and discharge instructions with expected improvement in urinary flow and follow-up for pathology results and uroflow/ post-void residual assessment.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    52332Cystoureteroscopy, with removal of foreign body or calculus by ureteroscopy, with lithotripsy (ureteral/renal)May be performed in the same operative session if concurrent stone disease requires endoscopic management prior to or after HoLEP.

    | 52000 | Cystourethroscopy (separate procedure) | Diagnostic cystoscopy performed preoperatively or intraoperatively to evaluate bladder and urethra prior to enucleation. |

    | 50948 | Extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy etc. | Listed for completeness when stone management is involved; may be separate encounter rather than concurrent. |

    | 50590 | Lithotripsy, extracorporeal shock wave; each additional renal/ureteral unit (List separately in some cases) | See note above regarding stone management coordination. |

    | 52601 | Transurethral excision and destruction of prostate tissue, simple (TURP), single stage | Alternative surgical approach for BPH; may be considered when HoLEP is not available or appropriate. |

    Related Modifiers

    13 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…
    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…
    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…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208800000XUrology PhysicianA urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has compreh…
    208C00000XColon & Rectal Surgery PhysicianA colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    261QC1500XCommunity Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    3336M0003XManaged Care Organization PharmacyA pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's c…
    2085D0003XDiagnostic Neuroimaging (Radiology) PhysicianA licensed physician, who has completed a residency program in Neurology, and who has additional training, experience, and competence in the standards…
    363LS0200XSchool Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    D49.2Neoplasm of unspecified behavior of bone, soft tissue, and skin
    E29.1Testicular hypofunction
    E78.5Hyperlipidemia, unspecified
    I10Essential (primary) hypertension
    N13.8Other obstructive and reflux uropathy
    N32.0Bladder-neck obstruction
    N39.0Urinary tract infection, site not specified
    N40.0Benign prostatic hyperplasia without lower urinary tract symptoms
    N40.1Benign prostatic hyperplasia with lower urinary tract symptoms
    N40.2Nodular prostate without lower urinary tract symptoms

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: General Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    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
    Inpatient Surgical Site of ServiceProvidence Health Plan2026-07-01
    Removal of Implantable DevicesBlue Cross Blue Shield - Rhode Island2026-07-01

    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-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

    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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