Urology services can be quite challenging to bill, especially the surgical procedures. That’s because the bundling rules and billing requirements can confuse even the most experienced billers. One such procedure is billed via CPT code 52356, and many billers make mistakes while filing claims for it.
That’s why we have created this detailed guide on CPT 52356. By the end of it, you will have all the information you need to file 52356 claims with confidence. So, let’s start.
CPT Code 52356 – Description
CPT code 52356 is defined as:
“Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type).”
Don’t feel overwhelmed with all these complex terms. Let’s simplify the definition.
Code 52356 is a urology billing code. It is used to bill a moderate-complexity surgery to treat kidney or ureteral stones. 52356 can be thought of as a global code. Why? Before its introduction, healthcare providers had to bill cystourethroscopy, ureteroscopy, pyeloscopy, and lithotripsy separately. With 52356, all of them can be billed under a single code.
When you bill CPT code 52356, you are reporting that the urologist:
- Performed a cystourethroscopy (inspected the bladder, urethra, prostate).
- Inserted a ureteroscope into the ureter for examination (ureteroscopy).
- And/or into the renal pelvis (pyeloscopy).
- Performed lithotripsy (using laser, ultrasound, or other energy to fragment a kidney stone).
- Inserted an indwelling ureteral stent (e.g., a Double-J stent) to ensure post-procedure urine drainage.
Scenarios Where CPT Code 52356 is Applicable
Now that we have simplified the description, let’s look at a couple of real-world scenarios in which CPT code 52356 can be used:
Obstructive Ureteral Calculus with Hydronephrosis
Suppose a man comes to the emergency room. He has severe pain on the left side of his back, along with nausea and vomiting. The attending physician in the ER orders an immediate imaging of the left kidney and ureter. The imaging results show a 7mm kidney stone in the ureter that carries urine from his kidney to his bladder. The stone is blocking urine flow and causing his kidney to swell.
The physician admits him and tries some conservative medications. However, they don’t help even after 48 hours, so he suggests surgery. The man is taken to the operating room. The urologist performs a cystourethroscopy, passes a guidewire, and advances a semi-rigid ureteroscope to reach the stone. Additionally, lithotripsy is performed to break the stone. Finally, a 6-French Double-J stent is placed in the left ureter to prevent swelling and obstruction.
The billing department can bill the entire procedure with CPT code 52356.
Recurrent Renal Calculi
A male with a history of recurrent kidney stones presents for a scheduled procedure. CT scans show a 1.2 cm stone in the right renal pelvis. The urologist performs a flexible ureteroscopy, navigating up to the right kidney. The stone is identified and dusted using laser lithotripsy.
Due to the volume of stone dust and potential for ureteral edema, the surgeon decides to place a temporary indwelling stent. Even though the stone was in the kidney rather than the ureter, the procedure involves ureteroscopy, lithotripsy, and stent placement, making CPT code 52356 the correct choice.
Applicable Modifiers for CPT Code 52356
The following are the most frequently used modifiers with CPT code 52356:
| Modifier | Short Description | Usage |
|---|---|---|
| 50 | Bilateral Procedure | Use when the procedure is performed on both left and right sides during the same operative session. |
| LT | Left Side | Use LT to indicate that the surgery was performed on the left side of the body. |
| RT | Right Side | Use RT to indicate that the surgery was performed on the right side of the body. |
| 52 | Significantly Reduced Scope | Applicable if the procedure was attempted but significantly reduced in scope. Note: If lithotripsy was performed but a stent was not placed, revert to CPT 52353 rather than using 52356 with modifier 52. |
| Modifier 59 or X{EPSU} | Separate Service | Indicates that the procedure was distinct or independent from other services performed on the same day. |
CPT Code 52356 vs. 52630
Here are some key distinctions between these two urology procedural codes.
CPT Code 52356
Cystourethroscopy with ureteroscopy and/or pyeloscopy; with lithotripsy, including insertion of an indwelling ureteral stent.
- Location: Ureter and kidney.
- Purpose: Used to break kidney or ureteral stones and prevent ureter blockage.
- Includes: Stone fragmentation AND placement of a ureteral stent (such as a double-J stent).
- Type: Upper urinary tract procedure.
CPT Code 52630
Transurethral resection; residual or regrowth of obstructive prostate tissue.
- Location: Prostate.
- Purpose: Used for repeat transurethral resection of prostate (TURP) to remove regrown or residual prostate tissue after a previous prostate surgery.
- Includes: Control of postoperative bleeding (complete procedure).
- Type: Prostate procedure for patients who have had prior prostate resection.
In Short
52356 = Treats kidney/ureteral stones with lithotripsy + stent placement.
52630 = Removes regrown prostate tissue (repeat prostate surgery only).
CPT Code 52356 – Billing & Reimbursement Guidelines
The following are some essential points that you should be aware of while filing claims for CPT code 52356:
Provide Detailed Documentation
Proper documentation is essential to justify the medical necessity of the procedure. It makes your case strong and reduces the chances of denials. For CPT code 52356, the documentation should include:
- Justification for the surgery (e.g., “intractable pain,” “hydronephrosis”).
- Details about the stone and its location (e.g., “proximal left ureter”) and size (e.g., “8 mm”).
- Clearly state that lithotripsy was performed (e.g., “Holmium laser was used to fragment the stone”).
- Confirm the insertion of the indwelling stent and its type/size.
- Clearly distinguish left, right, or bilateral.
Verify the Medicare Reimbursement Rate
Medicare currently pays around $365.07 nationally in both facility and non-facility settings for CPT code 52356, according to the 2026 Physician Fee Schedule.
However, this amount is the national average, and the actual payment varies for each location. This fluctuation is because of geographic practice cost indices (GPCIs) that adjust for regional cost differences.
Wrapping Up
CPT code 52356 is a urology billing code. It is used to bill a surgical process in which a stone is removed from a kidney or ureter. The procedure is complex and requires several steps. Before filing the claim, ensure you have used the correct CPT code, modifiers, and documentation to justify the procedure’s medical need.
The information we provided in this guide will help you file 52356 claims more accurately. However, medical billing and coding are complex processes, and it is better to let professionals handle them. Many companies, like MediBillMD, offer expert and affordable urology billing services that are sure to improve your revenue collection.
