Billing, Coding & Reimbursement

Reference tables for CPT procedure codes, ICD-10 diagnosis codes, and billing modifiers relevant to functional urology, GU reconstruction, and female pelvic medicine. Code descriptions are paraphrased and wRVU values are for educational reference. wRVUs are Medicare Physician Fee Schedule work RVUs from the CMS CY2026 relative value file (RVU26C, July 2026 release). The CY2026 conversion factor is $33.4009 ($33.5675 for clinicians who are qualifying APM participants). Values change each January, and "Carrier priced" codes have no national wRVU. Verify against the AMA CPT database and the CMS Physician Fee Schedule before billing.

Note on terminology. Several ICD-10 code descriptions below (e.g., F64.0 Transsexualism, Q56.0–Q56.4 Hermaphroditism / Pseudohermaphroditism, Z87.890 Personal history of sex reassignment) use clinical language that is now outdated and, in some cases, considered stigmatizing. The text is reproduced verbatim from the WHO/CMS code set because billing accuracy requires matching the official descriptor. In clinical documentation and patient-facing communication, use current terminology (e.g., differences of sex development (DSD), gender dysphoria or gender incongruence, gender-affirming surgery).

CPT Procedure Codes

All TypesAUSBPHBladder NeckBladder Recon / DiversionCystoscopyFistula RepairGenital ReconGraft HarvestHysterectomyOAB / Botox / PTNSOffice E/M add-onsPenile ProsthesisPeyronie'sProlapse RepairSacral NeuromodulationSling / SUITrauma / GenitalUpper Tract ReconUrethra OtherUrethroplastyUrodynamicsVaginal Recon / GAS246 results

CPT	Procedure Name	Type	wRVUs
53444	Insertion of tandem cuff (second cuff) artificial urinary sphincter	AUS	13.84
53445	Insertion of artificial urinary sphincter (bladder neck or urethra), all components	AUS	12.68
53446	Removal of artificial urinary sphincter (bladder neck or urethra), all components	AUS	10.74
53447	Removal and replacement of artificial urinary sphincter, all components	AUS	13.92
53448	Removal and replacement of artificial urinary sphincter, all components, infected field	AUS	22.85
53449	Repair of artificial urinary sphincter: cuff, pump, or reservoir	AUS	10.30
54400	Insertion of penile prosthesis; non-inflatable (malleable)	Penile Prosthesis	8.94
54405	Insertion of multi-component, inflatable penile prosthesis (3-piece IPP)	Penile Prosthesis	14.16
54406	Removal of all components of inflatable penile prosthesis without replacement	Penile Prosthesis	12.57
54408	Repair of component(s) of multi-component inflatable penile prosthesis	Penile Prosthesis	13.56
54410	Removal and replacement of all components of multi-component IPP (non-infected)	Penile Prosthesis	14.80
54411	Removal and replacement of all components of multi-component IPP (infected field)	Penile Prosthesis	17.89
54415	Removal of non-inflatable (malleable) penile prosthesis without replacement	Penile Prosthesis	8.66
54416	Removal and replacement of non-inflatable (malleable) penile prosthesis	Penile Prosthesis	11.78
54417	Removal and replacement of non-inflatable (malleable) penile prosthesis (infected field)	Penile Prosthesis	15.70
54110	Incision of penile plaque (Peyronie's disease)	Peyronie's	10.92
54111	Incision of penile plaque (Peyronie's); with grafting 5 cm or less	Peyronie's	14.42
54112	Incision of penile plaque (Peyronie's); with graft greater than 5 cm	Peyronie's	16.98
54200	Injection procedure for Peyronie's disease (e.g., collagenase)	Peyronie's	1.11
54205	Injection procedure for Peyronie's with surgical exposure of plaque	Peyronie's	8.97
54360	Plastic operation on penis to correct angulation	Peyronie's	11.44
53400	Urethroplasty; first stage, for fistula, diverticulum, or stricture (e.g., Johanson)	Urethroplasty	13.78
53405	Urethroplasty; second stage (formation of urethra), including urinary diversion	Urethroplasty	15.27
53410	Urethroplasty, 1-stage reconstruction of male anterior urethra	Urethroplasty	17.24
53415	Urethroplasty, transpubic or perineal, 1-stage, prostatic or membranous urethra	Urethroplasty	20.18
53420	Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage	Urethroplasty	14.79
53425	Urethroplasty, 2-stage; second stage	Urethroplasty	16.64
53430	Urethroplasty, reconstruction of female urethra	Urethroplasty	16.99
53431	Urethroplasty with tubularization of posterior urethra and/or lower bladder for incontinence (e.g., Tenago)	Urethroplasty	20.65
53450	Urethromeatoplasty, with mucosal advancement	Urethroplasty	6.60
53460	Urethromeatoplasty, with partial excision of distal urethral segment (Richardson)	Urethroplasty	7.56
53520	Closure of urethrostomy or urethrocutaneous fistula, male	Urethroplasty	9.24
52275	Cystourethroscopy with internal urethrotomy, male	Bladder Neck	4.57
52276	Cystourethroscopy with direct vision internal urethrotomy	Bladder Neck	4.87
52277	Cystourethroscopy with resection of external sphincter (sphincterotomy)	Bladder Neck	6.01
52450	Transurethral incision of prostate (TUIP) — applicable to bladder-neck contracture	Bladder Neck	7.59
52640	Transurethral resection or incision of postoperative bladder neck contracture (TUIBNC)	Bladder Neck	4.67
53860	Transurethral radiofrequency micro-remodeling of female bladder neck and urethra (SUI)	Bladder Neck	3.87
51840	Anterior vesicourethropexy (e.g., Marshall-Marchetti-Krantz), simple	Sling / SUI	11.08
51841	Anterior vesicourethropexy; complicated (e.g., secondary repair)	Sling / SUI	13.34
51845	Abdomino-vaginal vesical neck suspension (e.g., Stamey, Raz, modified Pereyra)	Sling / SUI	9.90
51990	Laparoscopic urethral suspension for stress incontinence	Sling / SUI	13.03
51992	Laparoscopic sling operation for stress incontinence (e.g., fascia or synthetic)	Sling / SUI	14.50
53442	Removal or revision of sling for male urinary incontinence	Sling / SUI	13.15
57288	Sling operation for stress incontinence (e.g., fascia or synthetic)	Sling / SUI	11.83
51715	Endoscopic injection of implant material into submucosal tissues of urethra/bladder neck (urethral bulking)	Urethra Other	3.64
53230	Excision of urethral diverticulum (separate procedure); female	Urethra Other	10.18
53235	Excision of urethral diverticulum; male	Urethra Other	10.72
53240	Marsupialization of urethral diverticulum, male or female	Urethra Other	6.90
51900	Closure of vesicovaginal fistula, abdominal approach	Fistula Repair	14.26
51920	Closure of vesicouterine fistula	Fistula Repair	13.07
51925	Closure of vesicouterine fistula with hysterectomy	Fistula Repair	17.09
57300	Closure of rectovaginal fistula; vaginal or perineal approach	Fistula Repair	8.49
57305	Closure of rectovaginal fistula with synchronous colostomy	Fistula Repair	14.97
57307	Closure of rectovaginal fistula with abdominal approach and/or revision of colostomy	Fistula Repair	16.74
57308	Closure of rectovaginal fistula; transperineal approach with perineal body reconstruction	Fistula Repair	10.33
57310	Closure of urethrovaginal fistula	Fistula Repair	7.46
57311	Closure of urethrovaginal fistula; with bulbocavernosus transplant	Fistula Repair	8.69
57320	Closure of vesicovaginal fistula; vaginal approach	Fistula Repair	8.66
57330	Closure of vesicovaginal fistula; transvesical and vaginal approach	Fistula Repair	12.88
45800	Closure of rectovesical fistula (rectourethral)	Fistula Repair	19.80
45805	Closure of rectovesical fistula with colostomy	Fistula Repair	22.74
51725	Simple cystometrography (e.g., spinal manometer)	Urodynamics	1.47
51726	Complex cystometrography (with or without voiding pressure or urethral pressure profile)	Urodynamics	1.67
51727	Complex cystometrography with urethral pressure profile	Urodynamics	2.06
51728	Complex cystometrography with voiding pressure studies	Urodynamics	2.06
51729	Complex cystometrography with voiding pressure studies and urethral pressure profile	Urodynamics	2.45
51736	Simple uroflowmetry (e.g., stop-watch flow rate, mechanical uroflow)	Urodynamics	0.17
51741	Complex uroflowmetry (e.g., calibrated electronic equipment)	Urodynamics	0.17
51784	Electromyography studies of anal or urethral sphincter, other than needle	Urodynamics	0.73
51785	Needle electromyography studies of anal or urethral sphincter, any technique	Urodynamics	1.49
51792	Stimulus evoked response (e.g., bulbocavernosus reflex latency)	Urodynamics	1.07
51797	Voiding pressure studies, intra-abdominal (rectal, gastric, intraperitoneal)	Urodynamics	0.78
51798	Measurement of post-void residual urine and/or bladder capacity by ultrasound	Urodynamics	0.00
58150	Total abdominal hysterectomy (corpus and cervix), with/without removal of tube(s)/ovary(s)	Hysterectomy	16.88
58152	Total abdominal hysterectomy with colpo-urethropexy	Hysterectomy	21.31
58180	Supracervical abdominal hysterectomy (subtotal)	Hysterectomy	16.19
58200	Total abdominal hysterectomy including partial vaginectomy; with para-aortic and pelvic lymph node sampling	Hysterectomy	22.52
58260	Vaginal hysterectomy, for uterus 250 g or less	Hysterectomy	13.80
58262	Vaginal hysterectomy, ≤250 g; with removal of tube(s) and/or ovary(s)	Hysterectomy	15.54
58263	Vaginal hysterectomy, ≤250 g; with adnexectomy and enterocele repair	Hysterectomy	16.80
58267	Vaginal hysterectomy, ≤250 g; with anterior and/or posterior colporrhaphy	Hysterectomy	17.90
58270	Vaginal hysterectomy, ≤250 g; with repair of enterocele	Hysterectomy	14.92
58290	Vaginal hysterectomy, >250 g	Hysterectomy	19.76
58291	Vaginal hysterectomy, >250 g; with adnexectomy	Hysterectomy	21.51
58292	Vaginal hysterectomy, >250 g; with adnexectomy and enterocele repair	Hysterectomy	22.77
58293	Vaginal hysterectomy, >250 g; with colporrhaphy	Hysterectomy	Not on CY2026 PFS
58294	Vaginal hysterectomy, >250 g; with repair of enterocele	Hysterectomy	21.01
58541	Laparoscopic supracervical hysterectomy, ≤250 g	Hysterectomy	11.98
58542	Laparoscopic supracervical hysterectomy, ≤250 g; with adnexectomy	Hysterectomy	13.81
58543	Laparoscopic supracervical hysterectomy, >250 g	Hysterectomy	14.03
58544	Laparoscopic supracervical hysterectomy, >250 g; with adnexectomy	Hysterectomy	15.21
58550	Laparoscopic-assisted vaginal hysterectomy (LAVH), ≤250 g	Hysterectomy	14.72
58552	LAVH, ≤250 g; with adnexectomy	Hysterectomy	16.49
58553	LAVH, >250 g	Hysterectomy	19.56
58554	LAVH, >250 g; with adnexectomy	Hysterectomy	22.53
58570	Laparoscopic total hysterectomy, ≤250 g	Hysterectomy	13.03
58571	Laparoscopic total hysterectomy, ≤250 g; with adnexectomy	Hysterectomy	14.63
58572	Laparoscopic total hysterectomy, >250 g	Hysterectomy	17.27
58573	Laparoscopic total hysterectomy, >250 g; with adnexectomy	Hysterectomy	20.27
56810	Perineoplasty, repair of perineum, nonobstetrical	Prolapse Repair	4.18
57106	Vaginectomy, partial removal of vaginal wall	Prolapse Repair	7.31
57110	Vaginectomy, complete removal of vaginal wall	Prolapse Repair	15.09
57120	Colpocleisis (Le Fort type)	Prolapse Repair	8.07
57200	Colporrhaphy, suture of injury of vagina (nonobstetrical)	Prolapse Repair	4.31
57210	Colporrhaphy, with extension to perineum	Prolapse Repair	5.57
57220	Plastic operation on urethral sphincter, vaginal approach (Kelly plication)	Prolapse Repair	4.73
57230	Plastic repair of urethrocele	Prolapse Repair	6.14
57240	Anterior colporrhaphy, repair of cystocele with or without urethrocele, includes cystoscopy	Prolapse Repair	9.83
57250	Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy	Prolapse Repair	9.83
57260	Combined anteroposterior colporrhaphy	Prolapse Repair	12.92
57265	Combined anteroposterior colporrhaphy with enterocele repair	Prolapse Repair	14.63
57267	Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site (add-on)	Prolapse Repair	4.76
57268	Repair of enterocele, vaginal approach (separate procedure)	Prolapse Repair	7.38
57270	Repair of enterocele, abdominal approach (separate procedure)	Prolapse Repair	13.33
57280	Colpopexy, abdominal approach (open sacrocolpopexy)	Prolapse Repair	16.30
57282	Colpopexy, vaginal extraperitoneal (sacrospinous, iliococcygeal)	Prolapse Repair	11.34
57283	Colpopexy, vaginal intraperitoneal (uterosacral, levator myorrhaphy)	Prolapse Repair	11.37
57284	Paravaginal defect repair; open abdominal approach	Prolapse Repair	13.97
57285	Paravaginal defect repair; vaginal approach	Prolapse Repair	11.31
57423	Paravaginal defect repair; laparoscopic approach	Prolapse Repair	15.68
57425	Laparoscopic colpopexy (sacrocolpopexy)	Prolapse Repair	16.60
57291	Construction of artificial vagina; without graft	Vaginal Recon / GAS	8.42
57292	Construction of artificial vagina; with graft	Vaginal Recon / GAS	13.66
57295	Revision (including removal) of prosthetic vaginal graft; vaginal approach	Vaginal Recon / GAS	7.62
57296	Revision of prosthetic vaginal graft; abdominal approach	Vaginal Recon / GAS	16.15
55970	Intersex surgery; male to female	Vaginal Recon / GAS	Carrier priced
55980	Intersex surgery; female to male	Vaginal Recon / GAS	Carrier priced
54300	Plastic operation of penis for straightening of chordee (e.g., hypospadias)	Genital Recon	10.92
54304	Plastic operation on penis for correction of chordee or first stage of fistula repair	Genital Recon	12.95
54308	Urethroplasty for second-stage hypospadias repair; ≤3 cm	Genital Recon	12.30
54312	Urethroplasty for second-stage hypospadias repair; >3 cm	Genital Recon	14.15
54316	Urethroplasty with free skin graft from area other than genitalia	Genital Recon	17.60
54318	Urethroplasty for third stage hypospadias repair to release penis from scrotum	Genital Recon	12.12
54322	One-stage distal hypospadias repair with simple meatal advancement (e.g., MAGPI, V-flap)	Genital Recon	13.63
54324	One-stage distal hypospadias repair with urethroplasty by local skin flaps (e.g., flip-flap, prepucial flap)	Genital Recon	17.11
54326	One-stage distal hypospadias repair with urethroplasty by local skin flaps and mobilization of urethra	Genital Recon	16.59
54328	One-stage distal hypospadias repair with extensive chordee dissection and urethroplasty (local flaps, graft patch and/or island flap)	Genital Recon	16.47
54332	One-stage proximal penile or penoscrotal hypospadias repair	Genital Recon	17.91
54336	One-stage perineal hypospadias repair	Genital Recon	21.08
54340	Repair of hypospadias complication (fistula, stricture, diverticulum); simple	Genital Recon	9.47
54344	Repair of hypospadias complication; with mobilization and skin flaps	Genital Recon	16.63
54348	Repair of hypospadias complication; with extensive dissection and urethroplasty	Genital Recon	17.86
54352	Repair of hypospadias cripple requiring extensive dissection and urethroplasty with flap or free graft	Genital Recon	25.48
54380	Plastic operation on penis for epispadias distal to external sphincter	Genital Recon	13.83
54385	Plastic operation on penis for epispadias distal to external sphincter; with incontinence	Genital Recon	16.15
54390	Plastic operation on penis for epispadias with exstrophy of bladder	Genital Recon	22.20
54420	Corpora cavernosa-saphenous vein shunt (priapism)	Genital Recon	12.08
54430	Corpora cavernosa-corpus spongiosum shunt (priapism)	Genital Recon	10.78
54435	Corpora cavernosa-glans penis fistulization for priapism (e.g., Winter, Al-Ghorab-type distal shunt)	Genital Recon	6.64
54437	Repair of traumatic corporeal tear(s) (penile fracture)	Genital Recon	11.21
54438	Replantation, penis, complete amputation including urethral repair	Genital Recon	Not on CY2026 PFS
54440	Plastic operation of penis for injury	Genital Recon	Carrier priced
54520	Orchiectomy, simple (including subcapsular)	Genital Recon	5.17
54690	Laparoscopy, surgical; orchiectomy	Genital Recon	11.41
55175	Scrotoplasty; simple	Genital Recon	5.72
55180	Scrotoplasty; complicated	Genital Recon	11.49
40818	Excision of mucosa of vestibule of mouth as donor tissue (oral mucosa graft harvest)	Graft Harvest	2.76
40819	Excision of frenum, labial or buccal	Graft Harvest	2.45
50845	Cutaneous appendico-vesicostomy (Mitrofanoff-type catheterizable channel)	Bladder Recon / Diversion	21.90
51550	Cystectomy, partial; simple	Bladder Recon / Diversion	16.80
51555	Cystectomy, partial, complicated (e.g., post-radiation, previous surgery)	Bladder Recon / Diversion	22.60
51565	Cystectomy, partial, with reimplantation of ureter(s) into bladder	Bladder Recon / Diversion	23.09
51570	Cystectomy, complete (simple cystectomy, benign disease)	Bladder Recon / Diversion	26.77
51575	Cystectomy, complete, with bilateral pelvic lymphadenectomy	Bladder Recon / Diversion	33.33
51580	Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations	Bladder Recon / Diversion	34.49
51585	Cystectomy, complete, with ureterosigmoidostomy and bilateral pelvic lymphadenectomy	Bladder Recon / Diversion	38.65
51590	Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including bowel anastomosis	Bladder Recon / Diversion	35.42
51595	Cystectomy, complete, with ureteroileal conduit and bilateral pelvic lymphadenectomy	Bladder Recon / Diversion	40.29
51596	Cystectomy, complete, with continent diversion to native or substitute bladder	Bladder Recon / Diversion	43.15
51960	Enterocystoplasty, including bowel anastomosis (ileocystoplasty / sigmoid cystoplasty)	Bladder Recon / Diversion	24.77
50820	Ureteroileal conduit (ileal loop diversion); including bowel anastomosis	Bladder Recon / Diversion	23.47
50825	Continent diversion to abdominal wall (Kock pouch, Indiana pouch, etc.)	Bladder Recon / Diversion	29.91
50830	Urinary undiversion (e.g., taking down ileal conduit, ureterosigmoidostomy)	Bladder Recon / Diversion	32.93
50840	Replacement of all or part of ureter by intestine segment, including anastomosis	Bladder Recon / Diversion	21.83
50860	Ureterostomy, transplantation of ureter to skin	Bladder Recon / Diversion	16.65
51980	Cutaneous vesicostomy	Bladder Recon / Diversion	12.26
50400	Pyeloplasty, plastic operation on renal pelvis with or without ureter; simple	Upper Tract Recon	20.74
50405	Pyeloplasty; complicated (congenital kidney abnormality, secondary, calycoplasty)	Upper Tract Recon	25.21
50544	Laparoscopic pyeloplasty	Upper Tract Recon	22.79
50760	Ureteroureterostomy	Upper Tract Recon	19.57
50770	Transureteroureterostomy	Upper Tract Recon	20.69
50780	Ureteroneocystostomy; anastomosis of single ureter to bladder	Upper Tract Recon	19.45
50782	Ureteroneocystostomy; anastomosis of duplicated ureter to bladder	Upper Tract Recon	19.17
50783	Ureteroneocystostomy; with extensive ureteral tailoring	Upper Tract Recon	20.18
50785	Ureteroneocystostomy; with vesico-psoas hitch or bladder flap	Upper Tract Recon	21.67
50800	Ureteroenterostomy, direct anastomosis of ureter to intestine	Upper Tract Recon	16.00
50810	Ureterosigmoidostomy with creation of sigmoid bladder and anastomosis (Mainz II)	Upper Tract Recon	22.04
50815	Ureterocolonic conduit, including bowel anastomosis	Upper Tract Recon	21.70
50650	Ureterectomy, with bladder cuff (separate procedure)	Upper Tract Recon	18.35
50722	Ureterolysis for ovarian or iliac vein syndrome	Upper Tract Recon	17.50
50725	Ureterolysis with reduction of vena cava (retrocaval ureter)	Upper Tract Recon	19.70
50727	Revision of urinary-cutaneous anastomosis (any type urostomy)	Upper Tract Recon	8.07
50728	Revision of urinary-cutaneous anastomosis with repair of fascial defect and hernia	Upper Tract Recon	11.88
52341	Cystourethroscopy with treatment of ureteral stricture (balloon, laser, electrocautery, incision)	Upper Tract Recon	5.22
52342	Cystourethroscopy with treatment of ureteropelvic junction stricture	Upper Tract Recon	5.70
52343	Cystourethroscopy with treatment of intra-renal stricture	Upper Tract Recon	6.39
52346	Cystourethroscopy with treatment of UPJ stricture (Acucise endopyelotomy)	Upper Tract Recon	8.37
64561	Percutaneous implantation of neurostimulator electrode array; sacral nerve (transforaminal), imaging guidance included	Sacral Neuromodulation	5.30
64581	Open implantation of neurostimulator electrode array; sacral nerve (transforaminal)	Sacral Neuromodulation	11.90
64585	Revision or removal of peripheral neurostimulator electrode array	Sacral Neuromodulation	2.06
64590	Insertion or replacement of peripheral, sacral or gastric neurostimulator pulse generator or receiver (pocket creation and connection to electrode array)	Sacral Neuromodulation	4.97
64595	Revision or removal of peripheral, sacral or gastric neurostimulator pulse generator or receiver	Sacral Neuromodulation	3.70
95970	Electronic analysis of implanted neurostimulator pulse generator, without programming	Sacral Neuromodulation	0.35
95971	Electronic analysis of implanted neurostimulator, simple programming (1–3 parameters)	Sacral Neuromodulation	0.78
95972	Electronic analysis of implanted neurostimulator, complex programming (more than 3 parameters)	Sacral Neuromodulation	0.80
52287	Cystoscopy with injection(s) for chemodenervation of the bladder (onabotulinumtoxinA)	OAB / Botox / PTNS	3.12
64566	Posterior tibial neurostimulation, percutaneous needle electrode, single treatment, programming included (PTNS; 000 global)	OAB / Botox / PTNS	0.59
0816T	Category III: open insertion/replacement of integrated tibial neurostimulation system, subcutaneous	OAB / Botox / PTNS	Carrier priced
0817T	Category III: open insertion/replacement of integrated tibial neurostimulation system, subfascial	OAB / Botox / PTNS	Carrier priced
0818T	Category III: revision or removal of integrated tibial neurostimulation system, subcutaneous	OAB / Botox / PTNS	Carrier priced
0819T	Category III: revision or removal of integrated tibial neurostimulation system, subfascial	OAB / Botox / PTNS	Carrier priced
0589T	Category III: electronic analysis of integrated tibial neurostimulator, simple programming	OAB / Botox / PTNS	Carrier priced
0590T	Category III: electronic analysis of integrated tibial neurostimulator, complex programming	OAB / Botox / PTNS	Carrier priced
99459	Pelvic examination add-on to an office E/M (practice-expense only, no work RVU; nonfacility PE RVU 0.52)	Office E/M add-ons	0.00
G2211	Visit complexity add-on to office E/M for longitudinal care of a serious or complex condition	Office E/M add-ons	0.33
52000	Cystourethroscopy (separate procedure)	Cystoscopy	1.49
52001	Cystourethroscopy with irrigation and evacuation of multiple obstructing clots	Cystoscopy	5.30
52005	Cystourethroscopy with ureteral catheterization, with or without irrigation/instillation/ureteropyelography	Cystoscopy	2.31
52204	Cystourethroscopy with biopsy(s)	Cystoscopy	2.53
52214	Cystourethroscopy with fulguration of trigone, bladder neck, prostatic fossa, urethra, periurethral glands	Cystoscopy	3.41
52224	Cystourethroscopy with fulguration or treatment of minor bladder lesion(s) <0.5 cm	Cystoscopy	3.95
52240	Cystourethroscopy with fulguration or treatment of large bladder tumor(s)	Cystoscopy	7.31
52310	Cystourethroscopy with removal of foreign body, calculus, or ureteral stent (simple)	Cystoscopy	2.74
52315	Cystourethroscopy with removal of foreign body, calculus, or ureteral stent; complicated	Cystoscopy	5.07
51702	Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)	Cystoscopy	0.49
51703	Insertion of temporary indwelling bladder catheter; complicated (altered anatomy, fractured catheter)	Cystoscopy	1.43
51045	Cystotomy with insertion of ureteral catheter or stent	Cystoscopy	7.61
51100	Aspiration of bladder; by needle	Cystoscopy	0.76
51102	Aspiration of bladder; with insertion of suprapubic catheter	Cystoscopy	2.63
52441	Cystourethroscopy with insertion of permanent adjustable transprostatic implant (UroLift); single	BPH	3.90
52442	Cystourethroscopy with insertion of permanent adjustable transprostatic implant; each additional	BPH	0.98
53854	Transurethral destruction of prostate tissue; by radiofrequency-generated water vapor (Rezūm)	BPH	5.78
52601	TURP, complete (includes vasectomy, meatotomy, internal urethrotomy, urethral calibration)	BPH	9.75
52630	TURP, residual or regrowth of obstructive tissue	BPH	6.39
52647	Laser coagulation of prostate	BPH	Not on CY2026 PFS
52648	Laser vaporization of prostate (PVP)	BPH	9.80
52649	Laser enucleation of prostate (HoLEP)	BPH	12.68
53850	Transurethral microwave thermotherapy of prostate (TUMT)	BPH	5.28
53852	Transurethral needle ablation of prostate (TUNA)	BPH	5.78
54600	Reduction of torsion of testis, surgical, with or without fixation of contralateral testis	Trauma / Genital	7.45
54620	Fixation of contralateral testis (separate procedure)	Trauma / Genital	5.08
54670	Suture or repair of testicular injury	Trauma / Genital	6.48
11004	Debridement of skin/subq/muscle/fascia for necrotizing soft tissue infection; external genitalia and perineum	Trauma / Genital	10.53
11005	Debridement of NSTI; abdominal wall	Trauma / Genital	13.88
11006	Debridement of NSTI; external genitalia, perineum and abdominal wall	Trauma / Genital	12.77

ICD-10 Diagnosis Codes

Check ICD-10-CM codes and descriptions against the CMS files effective on the date of service.^[23]

All ConditionsAUS ComplicationsAnorectalBNC / VUASBPH / ProstateBladder Recon IndicationCongenital / PediatricErectile DysfunctionFemale GenitalFistulaGender / GASHematuriaIPP ComplicationsIncontinenceInterstitial CystitisMesh ComplicationsNeurogenic BladderOAB / LUTSPeyronie's / PenilePriapismProlapseSexual DysfunctionSkin / LSTraumaUTIUpper TractUrethral StrictureVoiding Dysfunction247 results

ICD-10	Description	Notes	Condition
N39.3	Stress incontinence (male) (female)	—	Incontinence
N39.41	Urge incontinence	—	Incontinence
N39.42	Incontinence without sensory awareness	—	Incontinence
N39.43	Post-void dribbling	—	Incontinence
N39.44	Nocturnal enuresis	—	Incontinence
N39.45	Continuous leakage	May indicate fistula	Incontinence
N39.46	Mixed incontinence	Stress + urge components	Incontinence
N39.490	Overflow incontinence	—	Incontinence
N39.491	Coital incontinence	—	Incontinence
N39.492	Postural (urinary) incontinence	—	Incontinence
N39.498	Other specified urinary incontinence	—	Incontinence
R32	Unspecified urinary incontinence	—	Incontinence
T83.111A	Breakdown (mechanical) of implanted urinary sphincter, initial encounter	—	AUS Complications
T83.118A	Breakdown of other urinary devices and implants, initial encounter	—	AUS Complications
T83.121A	Displacement of implanted urinary sphincter, initial encounter	—	AUS Complications
T83.191A	Other mechanical complication of implanted urinary sphincter, initial encounter	—	AUS Complications
T83.591A	Infection and inflammatory reaction due to implanted urinary sphincter, initial encounter	—	AUS Complications
T83.598A	Infection due to other prosthetic device/implant in urinary system, initial encounter	—	AUS Complications
T83.71XA	Erosion of implanted mesh into organ or tissue (urinary), initial encounter	—	AUS Complications
T83.81XA	Embolism due to genitourinary prosthetic device, initial encounter	—	AUS Complications
T83.490A	Other mechanical complication of implanted penile prosthesis, initial encounter	—	IPP Complications
T83.491A	Breakdown of implanted penile prosthesis, initial encounter	—	IPP Complications
T83.492A	Displacement of implanted penile prosthesis, initial encounter	—	IPP Complications
T83.61XA	Infection and inflammatory reaction due to implanted penile prosthesis, initial encounter	—	IPP Complications
N52.01	Erectile dysfunction due to arterial insufficiency	—	Erectile Dysfunction
N52.02	Corporo-venous occlusive erectile dysfunction	—	Erectile Dysfunction
N52.03	Combined arterial insufficiency and corporo-venous occlusive ED	—	Erectile Dysfunction
N52.1	Erectile dysfunction due to diseases classified elsewhere	—	Erectile Dysfunction
N52.2	Drug-induced erectile dysfunction	—	Erectile Dysfunction
N52.31	Erectile dysfunction following radical prostatectomy	—	Erectile Dysfunction
N52.32	Erectile dysfunction following radical cystectomy	—	Erectile Dysfunction
N52.33	Erectile dysfunction following urethral surgery	—	Erectile Dysfunction
N52.34	Erectile dysfunction following simple prostatectomy	—	Erectile Dysfunction
N52.35	Erectile dysfunction following radiation therapy	—	Erectile Dysfunction
N52.36	Erectile dysfunction following interstitial seed therapy	—	Erectile Dysfunction
N52.37	Erectile dysfunction following prostate ablative therapy	—	Erectile Dysfunction
N52.39	Other and unspecified postprocedural erectile dysfunction	—	Erectile Dysfunction
N52.8	Other male erectile dysfunction	—	Erectile Dysfunction
N52.9	Male erectile dysfunction, unspecified	—	Erectile Dysfunction
N48.6	Induratio penis plastica (Peyronie's disease)	—	Peyronie's / Penile
N48.0	Leukoplakia of penis (includes lichen sclerosus of penis)	—	Peyronie's / Penile
N48.1	Balanoposthitis	—	Peyronie's / Penile
N48.2	Other inflammatory disorders of penis	—	Peyronie's / Penile
N48.81	Thrombosis of superficial vein of penis	—	Peyronie's / Penile
N48.82	Acquired buried penis	—	Peyronie's / Penile
N48.83	Sclerosing lymphangitis of penis	—	Peyronie's / Penile
N48.89	Other specified disorders of penis	—	Peyronie's / Penile
N48.30	Priapism, unspecified	—	Priapism
N48.31	Priapism due to trauma	—	Priapism
N48.32	Priapism due to disease classified elsewhere	—	Priapism
N48.33	Priapism, drug-induced	—	Priapism
N48.39	Other priapism	Ischemic, not elsewhere classified	Priapism
N35.010	Post-traumatic urethral stricture, male, meatal	—	Urethral Stricture
N35.011	Post-traumatic bulbous urethral stricture	—	Urethral Stricture
N35.012	Post-traumatic membranous urethral stricture	—	Urethral Stricture
N35.013	Post-traumatic anterior urethral stricture	—	Urethral Stricture
N35.014	Post-traumatic urethral stricture, male, unspecified	—	Urethral Stricture
N35.016	Post-traumatic urethral stricture, male, overlapping sites	Panurethral stricture	Urethral Stricture
N35.111	Postinfective urethral stricture NEC, male, meatal	—	Urethral Stricture
N35.112	Postinfective bulbous urethral stricture NEC	—	Urethral Stricture
N35.113	Postinfective membranous urethral stricture NEC, male	—	Urethral Stricture
N35.114	Postinfective anterior urethral stricture NEC, male	—	Urethral Stricture
N35.116	Postinfective urethral stricture NEC, male, overlapping sites	Panurethral stricture	Urethral Stricture
N35.119	Postinfective urethral stricture NEC, male, unspecified site	—	Urethral Stricture
N35.12	Postinfective urethral stricture NEC, female	—	Urethral Stricture
N35.811	Other urethral stricture, male, meatal	—	Urethral Stricture
N35.812	Other urethral bulbous stricture, male	—	Urethral Stricture
N35.813	Other urethral membranous stricture, male	—	Urethral Stricture
N35.814	Other anterior urethral stricture, male	—	Urethral Stricture
N35.816	Other urethral stricture, male, overlapping sites	Panurethral stricture	Urethral Stricture
N35.819	Other urethral stricture, male, unspecified site	—	Urethral Stricture
N35.82	Other urethral stricture, female	—	Urethral Stricture
N35.919	Unspecified urethral stricture, male, unspecified site	—	Urethral Stricture
N35.92	Unspecified urethral stricture, female	—	Urethral Stricture
N99.110	Postprocedural urethral stricture, male, meatal	—	Urethral Stricture
N99.111	Postprocedural bulbous urethral stricture	—	Urethral Stricture
N99.112	Postprocedural membranous urethral stricture	—	Urethral Stricture
N99.113	Postprocedural anterior bulbous urethral stricture	—	Urethral Stricture
N99.114	Postprocedural anterior urethral stricture, male	—	Urethral Stricture
N99.115	Postprocedural urethral stricture, male, unspecified	—	Urethral Stricture
N99.116	Postprocedural urethral stricture, male, overlapping sites	—	Urethral Stricture
N99.12	Postprocedural urethral stricture, female	—	Urethral Stricture
N32.0	Bladder-neck obstruction (bladder neck contracture)	Use for primary BNC, post-TURP BNC	BNC / VUAS
N99.89	Other postprocedural complications of GU system	Use for VUAS when no specific code applies	BNC / VUAS
N82.0	Vesicovaginal fistula	—	Fistula
N82.1	Other female urinary-genital tract fistulae	Includes ureterovaginal, urethrovaginal	Fistula
N82.2	Fistula of vagina to small intestine	—	Fistula
N82.3	Fistula of vagina to large intestine (rectovaginal fistula)	—	Fistula
N82.4	Other female intestinal-genital tract fistulae	—	Fistula
N82.5	Female genital tract-skin fistulae	—	Fistula
N82.8	Other female genital tract fistulae	—	Fistula
N82.9	Female genital tract fistula, unspecified	—	Fistula
N36.0	Urethral fistula	—	Fistula
N32.1	Vesicointestinal fistula	Vesicoenteric, vesicosigmoid, rectourethral male	Fistula
N32.2	Vesical fistula, not elsewhere classified	—	Fistula
K63.2	Fistula of intestine	Use with N36.0 for male rectourethral fistula	Fistula
N31.0	Uninhibited neuropathic bladder, NEC	—	Neurogenic Bladder
N31.1	Reflex neuropathic bladder, NEC	—	Neurogenic Bladder
N31.2	Flaccid neuropathic bladder, NEC	—	Neurogenic Bladder
N31.8	Other neuromuscular dysfunction of bladder	—	Neurogenic Bladder
N31.9	Neuromuscular dysfunction of bladder, unspecified	—	Neurogenic Bladder
N81.0	Urethrocele	—	Prolapse
N81.10	Cystocele, unspecified	—	Prolapse
N81.11	Cystocele, midline	—	Prolapse
N81.12	Cystocele, lateral	Paravaginal defect	Prolapse
N81.2	Incomplete uterovaginal prolapse	—	Prolapse
N81.3	Complete uterovaginal prolapse	—	Prolapse
N81.4	Uterovaginal prolapse, unspecified	—	Prolapse
N81.5	Vaginal enterocele	—	Prolapse
N81.6	Rectocele	—	Prolapse
N81.81	Perineocele	—	Prolapse
N81.82	Incompetence/disruption of pelvic floor muscles	—	Prolapse
N81.84	Cervical stump prolapse	Post-supracervical hysterectomy	Prolapse
N81.85	Cervicovaginal fistula	—	Prolapse
N81.89	Other female genital prolapse	—	Prolapse
N99.3	Prolapse of vaginal vault after hysterectomy	—	Prolapse
T83.711A	Erosion of implanted mesh into vagina, initial encounter	—	Mesh Complications
T83.712A	Erosion of implanted mesh to surrounding organ or tissue	—	Mesh Complications
T83.713A	Erosion of implanted urethral bulking agent	—	Mesh Complications
T83.718A	Erosion of other implanted mesh into organ or tissue	—	Mesh Complications
T83.721A	Exposure of implanted mesh into vagina, initial encounter	—	Mesh Complications
T83.722A	Exposure of implanted mesh into surrounding organ/tissue	—	Mesh Complications
T83.723A	Exposure of implanted urethral bulking agent	—	Mesh Complications
T83.728A	Exposure of other implanted mesh into organ or tissue	—	Mesh Complications
N32.81	Overactive bladder	Primary OAB diagnosis	OAB / LUTS
N32.89	Other specified disorders of bladder	Bladder pain syndrome	OAB / LUTS
R39.15	Urgency of urination	—	OAB / LUTS
R35.0	Frequency of micturition	—	OAB / LUTS
R35.1	Nocturia	—	OAB / LUTS
R35.89	Other polyuria	—	OAB / LUTS
R33.0	Drug-induced urinary retention	—	Voiding Dysfunction
R33.8	Other retention of urine	—	Voiding Dysfunction
R33.9	Retention of urine, unspecified	—	Voiding Dysfunction
R39.11	Hesitancy of micturition	—	Voiding Dysfunction
R39.12	Poor urinary stream	—	Voiding Dysfunction
R39.13	Splitting of urinary stream	—	Voiding Dysfunction
R39.14	Feeling of incomplete bladder emptying	—	Voiding Dysfunction
R39.16	Straining on urination	—	Voiding Dysfunction
R39.198	Other difficulties with micturition	—	Voiding Dysfunction
N13.8	Other obstructive and reflux uropathy	—	Voiding Dysfunction
N30.10	Interstitial cystitis (chronic) without hematuria	—	Interstitial Cystitis
N30.11	Interstitial cystitis (chronic) with hematuria	—	Interstitial Cystitis
N30.30	Trigonitis without hematuria	—	Interstitial Cystitis
N30.31	Trigonitis with hematuria	—	Interstitial Cystitis
R30.0	Dysuria	—	Interstitial Cystitis
R30.9	Painful micturition, unspecified	—	Interstitial Cystitis
R31.0	Gross hematuria	—	Hematuria
R31.1	Benign essential microscopic hematuria	—	Hematuria
R31.21	Asymptomatic microscopic hematuria	—	Hematuria
R31.29	Other microscopic hematuria	—	Hematuria
K62.3	Rectal prolapse	—	Anorectal
K62.89	Other specified diseases of rectum	—	Anorectal
R15.0	Incomplete defecation	Obstructed defecation	Anorectal
R15.1	Fecal smearing	—	Anorectal
R15.2	Fecal urgency	—	Anorectal
R15.9	Full incontinence of feces	—	Anorectal
N13.0	Hydronephrosis with ureteropelvic junction obstruction	Primary UPJO	Upper Tract
N13.1	Hydronephrosis with ureteral stricture, NEC	—	Upper Tract
N13.2	Hydronephrosis with renal and ureteral calculous obstruction	—	Upper Tract
N13.30	Unspecified hydronephrosis	—	Upper Tract
N13.39	Other hydronephrosis	—	Upper Tract
N13.4	Hydroureter	—	Upper Tract
N13.5	Crossing vessel and stricture of ureter without hydronephrosis	—	Upper Tract
N13.6	Pyonephrosis	—	Upper Tract
N13.70	Vesicoureteral-reflux, unspecified	—	Upper Tract
N13.71	Vesicoureteral-reflux without reflux nephropathy	—	Upper Tract
N13.721	VUR with reflux nephropathy without hydroureter, unilateral	—	Upper Tract
N13.722	VUR with reflux nephropathy without hydroureter, bilateral	—	Upper Tract
N13.731	VUR with reflux nephropathy with hydroureter, unilateral	—	Upper Tract
N13.732	VUR with reflux nephropathy with hydroureter, bilateral	—	Upper Tract
N28.81	Hypertrophy of kidney	—	Upper Tract
N28.82	Megaloureter	—	Upper Tract
N28.86	Ureteritis cystica	—	Upper Tract
N28.89	Other specified disorders of kidney and ureter	Use for retroperitoneal-fibrosis ureteric obstruction	Upper Tract
Q54.0	Hypospadias, balanic (glanular)	—	Congenital / Pediatric
Q54.1	Hypospadias, penile	—	Congenital / Pediatric
Q54.2	Hypospadias, penoscrotal	—	Congenital / Pediatric
Q54.3	Hypospadias, perineal	—	Congenital / Pediatric
Q54.4	Congenital chordee	—	Congenital / Pediatric
Q54.8	Other hypospadias	—	Congenital / Pediatric
Q54.9	Hypospadias, unspecified	—	Congenital / Pediatric
Q64.0	Epispadias	—	Congenital / Pediatric
Q64.10	Bladder exstrophy, unspecified	—	Congenital / Pediatric
Q64.11	Supravesical fissure of urinary bladder	—	Congenital / Pediatric
Q64.12	Cloacal exstrophy of urinary bladder	—	Congenital / Pediatric
Q64.19	Other exstrophy of urinary bladder	—	Congenital / Pediatric
Q64.2	Congenital posterior urethral valves	—	Congenital / Pediatric
Q64.31	Congenital bladder neck obstruction	—	Congenital / Pediatric
Q64.32	Congenital stricture of urethra	—	Congenital / Pediatric
Q64.5	Congenital absence of bladder and urethra	—	Congenital / Pediatric
Q64.6	Congenital diverticulum of bladder	—	Congenital / Pediatric
Q64.71	Congenital prolapse of urethra	—	Congenital / Pediatric
Q64.74	Double urethra	—	Congenital / Pediatric
Q64.75	Double urinary meatus	—	Congenital / Pediatric
Q43.7	Persistent cloaca	—	Congenital / Pediatric
Q56.0	Hermaphroditism, NEC	DSD spectrum	Congenital / Pediatric
Q56.1	Male pseudohermaphroditism, NEC	—	Congenital / Pediatric
Q56.2	Female pseudohermaphroditism, NEC	—	Congenital / Pediatric
Q56.3	Pseudohermaphroditism, unspecified	—	Congenital / Pediatric
Q56.4	Indeterminate sex, unspecified	—	Congenital / Pediatric
F64.0	Transsexualism	—	Gender / GAS
F64.1	Dual role transvestism	—	Gender / GAS
F64.2	Gender identity disorder of childhood	—	Gender / GAS
F64.8	Other gender identity disorders	—	Gender / GAS
F64.9	Gender identity disorder, unspecified	—	Gender / GAS
Z87.890	Personal history of sex reassignment	—	Gender / GAS
N89.5	Stricture and atresia of vagina	Vaginal stenosis	Female Genital
N89.6	Tight hymenal ring	—	Female Genital
N89.8	Other specified noninflammatory disorders of vagina	—	Female Genital
N90.4	Leukoplakia of vulva	—	Female Genital
N90.5	Atrophy of vulva	—	Female Genital
N90.60	Unspecified hypertrophy of vulva	—	Female Genital
N90.61	Childhood asymmetric labium majus enlargement	—	Female Genital
N90.69	Other specified hypertrophy of vulva	Labial hypertrophy	Female Genital
N94.10	Unspecified dyspareunia	—	Female Genital
N94.11	Superficial (introital) dyspareunia	—	Female Genital
N94.12	Deep dyspareunia	—	Female Genital
N94.818	Other vulvodynia	—	Female Genital
N95.2	Postmenopausal atrophic vaginitis (GSM)	—	Female Genital
L90.0	Lichen sclerosus et atrophicus	Penile/genital LS	Skin / LS
L73.2	Hidradenitis suppurativa	—	Skin / LS
N40.0	Benign prostatic hyperplasia without LUTS	—	BPH / Prostate
N40.1	Benign prostatic hyperplasia with LUTS	—	BPH / Prostate
N40.2	Nodular prostate without LUTS	—	BPH / Prostate
N40.3	Nodular prostate with LUTS	—	BPH / Prostate
N42.81	Prostatodynia syndrome	—	BPH / Prostate
N42.82	Prostatosis syndrome	—	BPH / Prostate
N42.83	Cyst of prostate	—	BPH / Prostate
S37.20XA	Unspecified injury of bladder, initial encounter	—	Trauma
S37.30XA	Unspecified injury of urethra, initial encounter	—	Trauma
S37.32XA	Laceration of urethra, initial encounter	—	Trauma
S39.840A	Fracture of corpus cavernosum penis, initial encounter	—	Trauma
S31.30XA	Unspecified open wound of penis, initial encounter	—	Trauma
N49.3	Fournier gangrene	—	Trauma
C67.9	Malignant neoplasm of bladder, unspecified	Use when cystectomy is for cancer	Bladder Recon Indication
D09.0	Carcinoma in situ of bladder	—	Bladder Recon Indication
N32.83	Detrusor hypertrophy	—	Bladder Recon Indication
F52.22	Female sexual arousal disorder	—	Sexual Dysfunction
F52.31	Female orgasmic disorder	—	Sexual Dysfunction
F52.6	Dyspareunia not due to a substance or known physiological condition	—	Sexual Dysfunction
N94.819	Vulvodynia, unspecified	—	Sexual Dysfunction
N39.0	Urinary tract infection, site not specified	—	UTI
N30.00	Acute cystitis without hematuria	—	UTI
N30.01	Acute cystitis with hematuria	—	UTI
N30.20	Other chronic cystitis without hematuria	—	UTI
N30.21	Other chronic cystitis with hematuria	—	UTI
Z87.440	Personal history of urinary (tract) infections	Recurrent UTI history	UTI

Modifiers

Modifiers are appended to CPT codes to indicate special circumstances.

Modifier	Name	When to Use
22	Increased Procedural Services	Document complexity beyond typical; specify additional time required
25	Significant, Separately Identifiable E/M	Same-day E/M beyond the usual pre- or post-procedure evaluation (for example a decision-making visit plus an office procedure). Append to the E/M code, never the procedure code, and document the E/M separately (AUGS Coding Committee 2025)
50	Bilateral Procedure	Procedure performed on both sides
51	Multiple Procedures	Two or more separate, non-bundled procedures in one session. For Medicare procedures subject to the standard multiple-surgery rule, the highest-valued code is paid at 100% and additional qualifying codes at 50% (AUGS Coding Committee 2026).[17]
52	Reduced Services	Procedure partially reduced or a component eliminated
53	Discontinued Procedure	Procedure stopped after anesthesia due to extenuating circumstances
58	Staged / Related Procedure	Planned staged procedure or more extensive follow-up in post-op period
59	Distinct Procedural Service	Bundling override for a truly distinct service (different session, site, organ, lesion or injury) when no more specific modifier applies. Not for E/M (use 25). Medicare asks for XE, XS, XP or XU when one fits. NCCI treats the pelvis as one region, so the note should name the separate pelvic-floor compartments
62	Co-Surgeon	Two primary surgeons performing distinct portions; each reports same CPT + 62
66	Surgical Team	Highly complex surgery requiring multiple specialties simultaneously
74	Discontinued Outpatient / ASC Procedure	Procedure aborted after anesthesia started in outpatient or ASC setting
76	Repeat Procedure — Same Physician	Same CPT, same patient, same day
77	Repeat Procedure — Different Physician	Same CPT, same patient, same day, different surgeon
78	Unplanned Return to OR	Unplanned same-physician return to the operating room for a related procedure during the post-op global period[17]
79	Unrelated Procedure in Post-op Period	Unrelated to primary procedure's post-op global
80	Assistant Surgeon	Primary surgeon bills CPT alone; assistant bills CPT + 80
82	Assistant Surgeon (No Qualified Resident)	Must justify. Primary uses CPT only; assistant uses CPT + 82
AS	PA / NP / CNS Assistant at Surgery	Reports the assist when performed by a non-physician
XE	Separate Encounter	Service distinct because it occurred during a separate encounter
XS	Separate Structure	Service distinct because performed on a separate organ or structure
XP	Separate Practitioner	Service distinct because performed by a different practitioner
XU	Unusual Non-Overlapping Service	Service does not overlap usual components of the main service
LT / RT	Left / Right Side	Designate side for unilateral procedures on paired organs

External Coding Resources

Resource	Description	Link
AMA CPT Code Lookup	Official AMA CPT code database (subscription)	ama-assn.org
CMS Physician Fee Schedule	CMS fee schedule lookup with current wRVU values	cms.gov
AAPC Coder	Comprehensive ICD-10 and CPT lookup tool	aapc.com
ICD-10-CM Browser	Official CMS ICD-10 browser	icd10data.com
NCCI Edits	CMS National Correct Coding Initiative bundling edits	cms.gov/ncci
AUA Coding Guides	AUA coding and reimbursement resources for urologists	auanet.org
CMS Medicare Coverage Database	LCD and NCD coverage-policy lookup by contractor and jurisdiction	cms.gov
AUGS Coding Resources	Urogynecology-specific coding guidance	augs.org

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Coding and Coverage Notes (2025–2026)

Dated practice notes from the AUGS Coding Committee commentaries and CMS documents. Re-check each January and against the local payer.

• E/M with procedures. When a significant, separately identifiable same-day E/M service is billed with a procedure, append modifier 25 to the E/M code, never to the procedure.^[17] A same-day procedure and E/M may require modifier 25, which generally prevents G2211 payment except with an eligible preventive service or vaccine administration; assess +99459 under its own add-on rules, so separating the visits is sometimes cleaner (Thompson 2025).^[1][17] Inside a global period, use 99024 for related follow-up. Unrelated care during a global period takes modifier 24 (E/M) or 79 (procedure).^[1]
• E/M level selection. Choose by medical decision-making or total time on the date of the visit. Prolonged-service code 99417 is added for each full 15 minutes beyond the highest code's minimum time (Davidson 2025).^[2] Medicare does not accept 99417 (status I on the CY2026 file) and uses G2212, which has its own time thresholds.
• +99459 (pelvic examination). Practice-expense-only add-on to an office E/M, once per patient per day, nonfacility settings only. Document the indication and chaperone presence (Price and Mamik 2025).^[3] Its RVUs are in the table above.
• G2211. Add-on for longitudinal care of a serious or complex condition, such as recurrent prolapse followed with a pessary. It generally cannot be reported when the same-day E/M carries modifier 25, except when an eligible preventive service or vaccine administration is also provided (Mamik and Price 2025).^[4][17]
• Modifiers 51, 59 and 22. Prolapse repair plus midurethral sling reports 57240 with 57288-51. Cystoscopy (52000) is bundled with a sling and is not unbundled. Reserve modifier 22 for work substantially greater than typical, with the reason, added time and specific challenges in the operative note (Molden 2026).^[5]
• Sacral neuromodulation. Code the electrode by approach: 64561 percutaneous (10-day global, imaging included) or 64581 open (90-day global; add 76000-26 for fluoroscopy interpretation). A peripheral nerve evaluation is 64561, with 95971 or 95972 when programmed. A replacement reports only the new lead and/or generator code (Muñoz and Davidson 2025).^[6]
• Urodynamics. Bill the highest-valued complex code first (51726–51729); add 51741-51 for complex uroflowmetry only when separately performed on a separate machine and medically necessary, and 51784/51785-51 for EMG only when medically necessary. 51797 needs no modifier.^[24] Post-void residual is bundled, and a simple cystometrogram is not combined with complex codes (Raza-Khan and Baker 2025).^[7]
• Implantable tibial nerve stimulation. Category III codes carry no national RVUs, so payers may ask for a comparable Category I code. Obtain prior authorization and document diagnosis and prior treatments (Shah and Panza 2026).^[8]
• Onabotulinumtoxin A coverage. LCD L35170, effective February 22, 2026, requires an objective OAB severity scale at baseline and at each follow-up, at least 12 weeks of standard treatment including behavioral and drug therapy, and 100 U for idiopathic OAB. Injections may not be repeated more often than every 12 weeks. These are local policies that other contractors may not have adopted (AUGS advisory; Hall 2026).^[9][10]
• Budget neutrality. When CMS projects a payment change above $20 million, it offsets it through the conversion factor. Overestimated G2211 use cut the 2024 factor by 2.18% when actual use was about 11% of E/M office visits rather than the projected 38% (Hall 2026).^[11]

Documentation for Office E/M Visits

Office and outpatient evaluation and management (E/M) visits, CPT 99202–99215, are leveled by one of two routes: the level of medical decision making (MDM) or the reporting clinician's total time on the date of the encounter. The AMA introduced this framework into CPT effective January 1, 2021,^[12] and Medicare adopted it through the CY2020 and CY2021 Physician Fee Schedule final rules.^[13][14] A medically appropriate history and examination are still documented, but their extent no longer determines the level.^[12] Visits in a reconstructive or functional practice center on medication decisions and surgical counseling, so MDM is usually the route that captures the work, and time is the better route for long counseling visits with little data.^[15]

New and Established Patients

CPT defines a new patient as one who has received no professional services within the past three years from the reporting clinician or from another clinician of the exact same specialty and subspecialty in the same group practice.^[16] Medicare's manual uses the phrase "same physician specialty", and a test interpretation billed without a face-to-face service does not make the patient established.^[17] An internal referral from a general urology partner to a reconstructive or FPMRS colleague in the same group is therefore a question for the billing office before the visit is coded as new.

Levels, MDM and Time

Code	Patient	MDM level	Total time on the date (met or exceeded)	CY2026 wRVUs
99202	New	Straightforward	15 min	0.93
99203	New	Low	30 min	1.60
99204	New	Moderate	45 min	2.60
99205	New	High	60 min	3.50
99211	Established	Not applicable (may not require the physician)	Not applicable	0.18
99212	Established	Straightforward	10 min	0.70
99213	Established	Low	20 min	1.30
99214	Established	Moderate	30 min	1.92
99215	Established	High	40 min	2.80

The 2021 descriptors gave time ranges (99212, for example, was 10–19 minutes). CPT 2024 removed the ranges, and each code now carries a single threshold that must be met or exceeded.^[12][18] Times and wRVUs are from the CY2026 relative value file.^[19]

MDM. MDM has three elements, and a level is reached when two of the three meet or exceed that level.^[16] The table below condenses the CPT grid.

MDM level	Problems addressed	Data reviewed and analyzed	Risk of management
Straightforward	One self-limited or minor problem	Minimal or none	Minimal
Low	Two or more minor problems, one stable chronic illness, or one acute uncomplicated illness	Limited: two category 1 items, or an independent historian	Low
Moderate	A chronic illness that is worsening, progressing or causing treatment side effects; two or more stable chronic illnesses; an undiagnosed new problem with uncertain prognosis; an acute illness with systemic symptoms	One of three categories: three category 1 items (an independent historian counts as one), an independent interpretation of a test, or a discussion of management with an external clinician	Moderate, for example prescription drug management, elective major surgery without identified risk factors, minor surgery with risk factors, or care significantly limited by social determinants of health
High	A chronic illness with severe exacerbation or side effects; an illness or injury that threatens life or bodily function	Two of the three categories	High, for example elective major surgery with patient or procedure risk factors, emergency major surgery, a decision about hospitalization, or drug therapy requiring intensive toxicity monitoring

The CPT definitions decide most audits:^[16]

• Addressed. A problem counts only when it is evaluated or treated at the encounter. A note that another clinician manages it, or a referral without evaluation, does not count.
• Stable. Stability is judged against the patient's own treatment goal. A chronic condition that is unchanged but not at goal is not stable.
• Category 1 items. Each unique test ordered or reviewed, and the notes from each unique external source, count once. Ordering a test includes review of its result, and repeated results of the same test count as one.
• Independent historian. A parent, guardian, spouse or other person gives history because the patient cannot give a complete or reliable one, or because confirmation is needed. Interpreter services do not count.
• Independent interpretation. The clinician interprets a test that has a CPT code and is not billed by that clinician, such as outside retrograde urethrogram or CT images, and records the reading.
• External discussion. An interactive exchange with a clinician outside the group or specialty, such as the referring urologist or radiation oncologist. Sending a note does not qualify.
• Separately billed services. A test or procedure whose professional component the same clinician reports, such as urodynamics or office cystoscopy, is not also counted as data.

Time. Total time includes the clinician's own work on the date of the encounter: preparing, reviewing outside records, examining, counseling, ordering, communicating with other clinicians, documenting and coordinating care. It excludes work normally done by clinical staff, travel and the time spent on any separately reported procedure.^[16] Medicare requires the full time for the level (no midpoint rounding) and a record of total time or start and stop times.^[20] Prolonged time begins at different points for the two prolonged codes. CPT 99417 is added once time exceeds the level 5 threshold by 15 minutes (75 minutes with 99205, 55 minutes with 99215).^[16] Medicare's G2212 starts at 89 minutes with 99205 and 69 minutes with 99215, with a further unit for each additional 15 minutes.^[17][20]

Worked Examples

These examples apply the CPT grid;^[16] the clinical details are illustrative.

New patient with post-prostatectomy incontinence considering an AUS. A man referred two years after radical prostatectomy uses four pads a day despite pelvic floor therapy. The urologist reviews the referring urologist's notes and the hospital's operative and pathology reports (two unique external sources) and the latest PSA (one test), examines him, performs office cystoscopy, and counsels him on a male sling and an AUS; he chooses the AUS.

• Problems: moderate. Incontinence that is not at the patient's goal is a chronic illness with treatment side effects, not a stable one.
• Data: moderate. Three category 1 items. The cystoscopy is billed as 52000 and adds nothing to data.
• Risk: moderate for a decision about elective major surgery without risk factors; high if the note names patient or procedure risk factors such as prior pelvic radiation or anticoagulation.
• Result: moderate MDM, 99204 with modifier 25, plus 52000. High risk alone does not reach 99205. If the urologist also personally reads the outside urethrogram images and records the interpretation, data become extensive (two categories), and extensive data with high risk support 99205.
• By time, 45 minutes of the urologist's own work on the date, excluding the cystoscopy, also supports 99204.

Established patient with recurrent UTI on prophylaxis. A postmenopausal woman returns on nightly prophylaxis and vaginal estrogen.

• Breakthrough infections: she has had two culture-proven infections since the last visit. The urologist reviews the outside cultures (one unique test) and orders renal and bladder ultrasound (a second test), for limited data. The problem is a chronic illness that is progressing on treatment (moderate), and the prophylactic regimen is changed, which is prescription drug management (moderate). Two elements at moderate support 99214 even though data are only limited. A bladder-scan residual billed as 51798 is not also counted as data.
• At goal: she has had no infections in six months. The urologist reviews one surveillance culture and a creatinine ordered by her primary care physician (two unique tests, limited data) for one stable chronic illness (low). Two elements at low support 99213.
• When the urologist is the continuing focal point for this condition, G2211 may also apply, subject to the same-day procedure restriction in the coding notes above.^[4]

Documentation Pitfalls

• Cloned notes. Copy-forward text and templates raise questions of authorship, accuracy and medical necessity, and institutions and payers have written policies on copied and imported EHR text.^[21] The note should show what was addressed at this visit. Medicare's improper-payment program lists established office visits among the three leading E/M error categories, with errors from insufficient documentation, medical necessity and incorrect coding.^[22]
• Unsupported time. A generic time attestation does not show that the time was the clinician's, was on the date of service, and excluded the procedure. State the total minutes and what they covered.^[16][20]
• Uncredited data. Data the clinician used but did not name earn no credit. The note should name each external source and test, the historian and why the historian was needed, a one-line independent interpretation, and whom the plan was discussed with.^[16]
• Unrecorded status and options. The problem's status against goal decides between stable and progressing. Management options considered and declined after shared decision making count toward risk only when the note records them.^[16]
• Listed but not addressed. Comorbidities copied into the assessment without evaluation or treatment do not add problems.^[16]

Same-Day Procedures, Modifier 25 and Global Periods

Modifier 25 goes on the E/M code when the E/M is significant and separately identifiable, above the usual pre- and postprocedure work of a same-day procedure; different diagnoses are not required, but both services must be documented (see the Modifiers tab).^[16][17] A practical test is whether the E/M portion, written up on its own, would stand as a billable visit, and whether it covers a different problem or work beyond the procedure.^[15] Evaluating a new SUI referral and deciding on an AUS, then performing cystoscopy the same day, meets that test. A return visit booked for a planned office cystoscopy or bladder onabotulinumtoxinA injection, with no new problem, does not: for minor procedures, Medicare treats the decision made immediately beforehand as routine preoperative work.^[17]

For a procedure with a 90-day global, an E/M on the day of or the day before surgery that results in the initial decision to operate takes modifier 57 rather than 25; an example is an inpatient consultation for an infected penile prosthesis that leads to explantation the same day. Modifier 57 is not used for 0-day or 10-day procedures.^[17]

The global package covers related preoperative visits from the day before a major (090) procedure or the day of a minor (000 or 010) procedure, the operation, complications not requiring a return to the operating room, and related postoperative visits (reported as 99024).^[17] In the CY2026 file, office cystoscopy (52000), bladder chemodenervation (52287) and urethral bulking (51715) carry 0-day globals; percutaneous sacral lead placement (64561) and Peyronie's plaque injection (54200) carry 10-day globals; AUS (53445), three-piece IPP (54405), sling (57288), anterior urethroplasty (53410) and open sacral lead placement (64581) carry 90-day globals.^[19] A visit inside a global for an unrelated problem, such as a new erectile dysfunction evaluation at the six-week AUS activation visit, is reported with modifier 24 and documented as unrelated.^[15][17]

Operative Notes

Coders assign procedure codes from two parts of the operative note. The procedures-performed list names every separately reportable procedure, and some surgeons add the CPT code and any modifier with its supporting statement. The narrative describes each procedure in its own labeled part, so that a combined case such as a sling with prolapse repair can be matched line by line to its codes. Reporting component codes when a comprehensive code exists is unbundling, which is denied and creates compliance exposure.^[15]

Estimating Clinic wRVUs

Under wRVU-based compensation, clinic output can be estimated from the visit and procedure mix. Twenty established visits split evenly between 99213 and 99214 generate about 32 wRVUs (10 × 1.30 plus 10 × 1.92); each same-day office cystoscopy adds 1.49, and the E/M is added only when modifier 25 is supported.^[19] Category III and carrier-priced codes, such as implantable tibial nerve stimulation, have no national work RVU, so any wRVU credit for them under an employment contract is set by the employer and is worth settling before the service line starts. The RVU components, conversion factor and payment models are covered in Healthcare Finance & Payment Models.

References

1. Thompson CD. Tips for office procedural coding. Urogynecology (Phila). 2025;31(10):911–912. doi:10.1097/SPV.0000000000001747

2. Davidson ERW. Evaluation and management (E/M) coding. Urogynecology (Phila). 2025;31(12):1085–1086. doi:10.1097/SPV.0000000000001717

3. Price JR, Mamik MM. CPT code +99459: it's worth understanding. Urogynecology (Phila). 2025;31(2):86–87. doi:10.1097/SPV.0000000000001649

4. Mamik MM, Price JR. G2211 coding guidance in urogynecology. Urogynecology (Phila). 2025;31(6):557–558. doi:10.1097/SPV.0000000000001689

5. Molden S. Choosing between surgical modifiers -51, -59, and -22: practical urogynecology examples. Urogynecology (Phila). 2026;32(8):897–899. doi:10.1097/SPV.0000000000001861

6. Muñoz JM, Davidson ERW. Coding for sacral neuromodulation. Urogynecology (Phila). 2025;31(11):999–1000. doi:10.1097/SPV.0000000000001758

7. Raza-Khan F, Baker M. Coding for urodynamic procedures. Urogynecology (Phila). 2025;31(9):825–826. doi:10.1097/SPV.0000000000001728

8. Shah NM, Panza J. Use of T codes for implantable tibial nerve stimulation. Urogynecology (Phila). 2026;32(9):1019–1020. doi:10.1097/SPV.0000000000001876

9. American Urogynecologic Society. Practice advisory: CMS LCD L35170, onabotulinumtoxinA (Botox), effective February 22, 2026. AUGS; 2026.

10. Hall EF. CMS Botox coverage updates: key requirements for urologic use. Urogynecology (Phila). 2026;32(7):771–772. doi:10.1097/SPV.0000000000001882

11. Hall EF. Budget neutrality, physician reality: how CMS budget rules affect physicians. Urogynecology (Phila). 2026;32(5):475–476. doi:10.1097/SPV.0000000000001827

12. American Medical Association. CPT Evaluation and Management (E/M) Office or Other Outpatient (99202–99215) and Prolonged Services (99354, 99355, 99356, 99417) Code and Guideline Changes, effective January 1, 2021 (with technical corrections of March 9, 2021). Chicago, IL: AMA; 2021. ama-assn.org

13. Centers for Medicare & Medicaid Services. Medicare program; CY 2020 revisions to payment policies under the Physician Fee Schedule and other changes to Part B payment policies. Final rule. Fed Regist. 2019;84:62568. November 15, 2019. govinfo.gov

14. Centers for Medicare & Medicaid Services. Medicare program; CY 2021 payment policies under the Physician Fee Schedule and other changes to Part B payment policies. Final rule. Fed Regist. 2020;85:84472. December 28, 2020. govinfo.gov

15. AUA Young Urologists Committee. Transitioning from Residency to Practice Manual. 8th ed. Linthicum, MD: American Urological Association; 2025.

16. American Medical Association. CPT Evaluation and Management (E/M) Code and Guideline Changes, effective January 1, 2023. Chicago, IL: AMA; 2022. ama-assn.org

17. Centers for Medicare & Medicaid Services. Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners, sections 30.6.6, 30.6.7, 30.6.15.2 and 40.1–40.2. Rev. 13316; July 24, 2025. cms.gov

18. American Medical Association. AMA releases the CPT 2024 code set [press release]. September 8, 2023. ama-assn.org

19. Centers for Medicare & Medicaid Services. Physician Fee Schedule relative value file RVU26C (July 2026 release). cms.gov

20. Centers for Medicare & Medicaid Services. Evaluation and Management Services. MLN Booklet MLN006764. May 2026. cms.gov

21. Weis JM, Levy PC. Copy, paste, and cloned notes in electronic health records: prevalence, benefits, risks, and best practice recommendations. Chest. 2014;145(3):632–638. doi:10.1378/chest.13-0886

22. Centers for Medicare & Medicaid Services. Complying with Medical Record Documentation Requirements. MLN Fact Sheet MLN909160. October 2024. cms.gov

23. Centers for Medicare & Medicaid Services. ICD-10-CM Code Files. cms.gov (accessed October 2026).

24. American Medical Association. September 2022 AMA/Specialty Society RVS Update Committee Meeting Minutes. ama-assn.org