52235 Cystoscopy and treatment
What 52235 is
CMS fee schedule short descriptor: Cystoscopy and treatment.
Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.
Medicare payment for 52235 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 5.30 | 1.64 | 0.68 | 7.62 | $254.51 |
| Facility (hospital, ASC) | 5.30 | 1.64 | 0.68 | 7.62 | $254.51 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply (endoscopic or minor procedure: global period is the day of the procedure).
Medically Unlikely Edit (MUE)
Medicare caps 52235 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Anatomic Consideration. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with 52235? These codes are bundled into it
52235 is a Column 1 code in 267 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
00910 | Anes transurethral px nos | 0 - no modifier bypass | Check pair |
00912 | Anes trurl px rescj bldr tum | 0 - no modifier bypass | Check pair |
00916 | Anes trurl px rescj bleeding | 0 - no modifier bypass | Check pair |
0213T | Njx paravert w/us cer/thor | 0 - no modifier bypass | Check pair |
0216T | Njx paravert w/us lumb/sac | 0 - no modifier bypass | Check pair |
0420U | 1 - modifier may bypass | Check pair | |
0596T | Temp fml iu vlv-pmp 1st insj | 0 - no modifier bypass | Check pair |
0597T | Temp fml iu valve-pmp rplcmt | 0 - no modifier bypass | Check pair |
0708T | Id ca immntx prep & 1st njx | 1 - modifier may bypass | Check pair |
0709T | Id ca immntx each addl njx | 1 - modifier may bypass | Check pair |
0903T | Ecg alg 12 lead reduced i&r | 1 - modifier may bypass | Check pair |
0904T | Ecg alg 12 ld rdcd trcg only | 1 - modifier may bypass | Check pair |
0905T | Ecg alg 12 ld rdcd i&r only | 1 - modifier may bypass | Check pair |
0943T | Cysto flx rmvl urtl scaffold | 0 - no modifier bypass | Check pair |
11000 | Dbrdmt ecz/infected skin<10% | 1 - modifier may bypass | Check pair |
11001 | Dbrdmt ecz/infct skn ea addl | 1 - modifier may bypass | Check pair |
11004 | Dbrdmt skin xtrnl gent&per | 1 - modifier may bypass | Check pair |
11005 | Dbrdmt skin abdominal wall | 1 - modifier may bypass | Check pair |
11006 | Dbrdmt skin xtrnl gent per | 1 - modifier may bypass | Check pair |
11042 | Dbrdmt subq tis 1st 20sqcm/< | 1 - modifier may bypass | Check pair |
11043 | Dbrdmt musc&/fsca 1st 20/< | 1 - modifier may bypass | Check pair |
11044 | Dbrdmt bone 1st 20 sq cm/< | 1 - modifier may bypass | Check pair |
11045 | Dbrdmt subq tiss each addl | 1 - modifier may bypass | Check pair |
11046 | Dbrdmt musc&/fsca ea addl | 1 - modifier may bypass | Check pair |
11047 | Dbrdmt bone each addl | 1 - modifier may bypass | Check pair |
12001 | Rpr s/n/ax/gen/trnk 2.5cm/< | 1 - modifier may bypass | Check pair |
12002 | Rpr s/n/ax/gen/trnk2.6-7.5cm | 1 - modifier may bypass | Check pair |
12004 | Rpr s/n/ax/gen/trk7.6-12.5cm | 1 - modifier may bypass | Check pair |
12005 | Rpr s/n/a/gen/trk12.6-20.0cm | 1 - modifier may bypass | Check pair |
12006 | Rpr s/n/a/gen/trk20.1-30.0cm | 1 - modifier may bypass | Check pair |
Showing 30 of 267 column 2 codes. Use the pair checker for any specific combination.
52235 is bundled into these codes
52235 appears as a Column 2 code in 9 active edits. Reported with one of these Column 1 codes on the same date of service, 52235 is the code that denies.
| Column 1 code | Short description | Modifier indicator | |
|---|---|---|---|
0942T | Cysto flx rmv&rplc urtl scaf | 0 | Check pair |
52250 | Cystoscopy and radiotracer | 1 | Check pair |
52352 | Cystouretero w/stone remove | 1 | Check pair |
52353 | Cystouretero w/lithotripsy | 1 | Check pair |
52354 | Cystouretero w/biopsy | 1 | Check pair |
52356 | Cysto/uretero w/lithotripsy | 1 | Check pair |
52648 | Laser surgery of prostate | 1 | Check pair |
52649 | Prostate laser enucleation | 1 | Check pair |
C9761 | 1 | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.