CPT 52235
Updated 5/7/2025
Reviewed by Nathan Liu, MD

Transurethral cystoscopy with fulguration of medium bladder lesions

Description

This procedure involves the inspection of the urethra and bladder using a cystoscope. During the cystoscopy, medium lesions measuring between 2.0 cm and 5.0 cm are treated through techniques such as fulguration, cryosurgery, or laser surgery.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$276.56
Limiting Charge$302.14
Patient Coinsurance (20%)$55.31

RVU Calculation Breakdown

Work RVU
5.44
Practice Expense RVU
2.46
Malpractice RVU
0.65
Total RVU
8.55
5.44 + 2.46 + 0.65 = 8.55
8.55 RVUs×$32.3465 Conversion Factor
$276.56

Non-Facility Setting

Procedure PriceN/A
Limiting ChargeN/A
Patient Coinsurance (20%)N/A
Not billable under PFS in non-facility setting

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2026), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

$3,448.97

Calculation:

x=$3,448.97

Patient Copayment / Coinsurance

$689.80

Calculation breakdown:

  • Minimum (20% of rate)$689.80
Medicare Ambulatory Surgical Center Reimbursement (ASC)

ASC Payment Rate

$1,655.31

Calculation:

x=$1,655.31

Patient Copayment / Coinsurance

$331.06

Standard copayment (20%):$331.06

Multiple procedure discount applies

When performed with other applicable procedures during the same session, this procedure may be subject to a payment reduction.

Top Modifiers

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HCPCS/CPT 51Multiple procedures performed by the same provider(36%)
HCPCS/CPT 59Distinct procedural service for non-E/M services(15.46%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(15.15%)
HCPCS/CPT XSSeparate structure service on distinct organ or structure(6.79%)
HCPCS/CPT XUUnusual non-overlapping service(6.02%)
HCPCS/CPT 58Staged or related procedure by the same physician during postoperative period(3.82%)
HCPCS/CPT 22Increased procedural services due to unusual complexity(3.28%)
HCPCS/CPT 79Unrelated procedure by the same physician during the postoperative period(3.06%)
HCPCS/CPT RTRight side procedure modifier(2.16%)
HCPCS/CPT LTModifier for procedures performed on the left side of the body(2.02%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)