Urology CPT codes are the numerical labels that describe every procedure a urologist performs, from simple bladder exams to advanced surgeries. Using the correct code ensures proper billing and reimbursement. This guide explains common CPT codes for urology. It also highlights important 2026 updates, including Medicare changes and key differences between 2025 and 2026. We will cover everything from basic cystoscopy CPT codes to new laparoscopic surgery codes, so urology providers know what to use for each procedure.
Why Learning New Urology CPT Codes Matters?
Why CPT codes matter: Using the correct code is important for urology coding. It ensures the urology practice gets paid correctly and stays compliant with billing rules. For example, a common code like 52000 means a basic bladder examination with a scope (cystoscopy). If a different procedure is done, a different code must be used.
Separate codes for each service: Many urology procedures have their own codes. For instance, a simple diagnostic cystourethroscopy (looking into the bladder and urethra with a scope) has a base code 52000. If additional tasks are done during the cystoscopy (like taking a biopsy or inserting catheters), different CPT codes apply (such as 52005 for cystoscopy with ureteral catheterization). Each code precisely describes what was done.
Always check if a procedure has a specific CPT code. Urologists should document details (like “with biopsy” or “with stent placement”) because these details point to the correct CPT code. Incomplete documentation can lead to using a generic code and lower reimbursement.
Urology CPT Codes and Procedures Providers Must Know in 2026
Urologists perform a wide range of procedures. Here are some common urology procedures and their CPT codes, explained in simple terms:
- Cystoscopy (Bladder Endoscopy):
The CPT code for a basic diagnostic cystoscopy (also called cystourethroscopy) is 52000. This procedure involves inserting a small tube with a camera (a cystoscope) through the urethra to look inside the bladder. It helps diagnose issues like bladder tumors, stones, or infections. If the cystoscopy includes extra steps (like taking a biopsy or flushing out blood clots), there are different codes (52001, 52005, etc.) that bundle those services. The CPT code for cystoscopy with biopsy would be different from a simple look-only cystoscopy. Urologists must pick the code that matches exactly what was done.
- Laparoscopic Urology Surgeries:
Many urology surgeries can be done with tiny instruments through small cuts (laparoscopic surgery) instead of a big surgical incision. There are special CPT codes for laparoscopic procedures in urology. Two important examples are:
CPT Code 51990: This is used for a laparoscopic surgical suspension of the urethra using sutures. In simple terms, the surgeon uses a scope and small tools to lift and support the urethra by stitching it to nearby tissues. This helps treat stress incontinence (leakage of urine when coughing or sneezing).
CPT Code 51992: This code also represents a laparoscopic urethral suspension, but specifically by placing a sling (a strip of material) at the bladder neck and urethra junction. It’s another way to treat urinary incontinence using a sling to support the urethra. Both 51990 and 51992 are minimally invasive surgeries (done with a camera and small instruments) to help patients who have trouble controlling urine.
Why two codes? The difference is in the technique: 51990 involves multiple sutures (stitches) without a sling, while 51992 involves placing a sling graft. Urologists choose the code that matches the method used to support the urethra.
- Transurethral Prostate Surgery (TURP):
CPT Code 52601 is used for a common prostate surgery called Transurethral Resection of the Prostate (TURP). In a TURP, the surgeon inserts an instrument through the urethra (no external incision) to remove part of the prostate gland. This helps men who have trouble urinating due to an enlarged prostate. Importantly, code 52601 is comprehensive; it already includes related steps like any urethral dilation, a small bladder cut (meatotomy), or a cystoscopy done during the TURP. Medicare and insurers consider those steps part of the TURP, so you should not bill them separately. For example, if a cystoscopy is done as part of a TURP, you only bill 52601, not a separate cystoscopy code, because 52601 covers it.
Other Prostate Procedures:
Urologists have other codes for treating the prostate:
CPT Code 52648: Another transurethral surgery for benign prostate hyperplasia (enlarged prostate), often used for certain methods like laser or more extensive resection.
Aquablation (Waterjet Surgery) – CPT Code 52597: New for 2026, 52597 is a code for transurethral robotic-assisted waterjet resection of the prostate. This high-tech procedure, known as Aquablation, uses a water jet to remove prostate tissue. It was previously a Category III code (0421T) but is now a Category I CPT code in 2026 due to its proven use. Aquablation is an alternative to TURP that is robotic and precise, and now it has its own CPT code for billing.
Laser and Other Technologies: (Note: code changes here) There used to be a code 52647 for laser coagulation of the prostate. However, 52647 is deleted in 2026. If a urologist uses laser ablation for the prostate, they will need to use an appropriate alternative code or new code (depending on the specifics of the procedure) since 52647 is no longer valid.
Cystourethroscopy with Treatment: If a cystoscopy is done not just for looking but also to treat a problem, the code changes. For example, CPT Code 52400 is for a cystourethroscopy that treats a congenital obstruction (posterior urethral valves) by cutting or fulgurating (burning) them. In other words, 52400 means the urologist looked into the bladder and also fixed a blockage that the patient was born with. This is different from a simple diagnostic cystoscopy (52000). Always use the code that includes any treatment done during the scope.
Urology uses a variety of CPT codes for different services. Knowing these codes helps ensure each procedure is billed correctly.
Key Urology CPT Code Changes in 2026
The year 2026 brings several important CPT coding changes for urology. It is crucial for urologists and coding staff to know what’s new, what’s revised, and what’s deleted. Here are the highlights of changes from 2025 to 2026:
Prostate Biopsy Codes Overhaul: One of the biggest changes for 2026 is how prostate biopsies are coded. In 2025, there was a single code (55700) for a prostate biopsy by any approach. In 2026, code 55700 is deleted. It is replaced by nine new Urology CPT codes (55707–55715) that are specific to the biopsy technique and guidance method. These new codes bundle in the imaging guidance. For example:
- 55707 – Prostate biopsy via transrectal approach with ultrasound guidance.
- 55709 – Prostate biopsy via transperineal approach with ultrasound guidance.
- 55708 and 55710 – Similar to above but with MRI-ultrasound fusion guidance for transrectal and transperineal approaches.
- 55711 and 55712 – Codes for biopsies that are targeted lesions only under MRI-ultrasound fusion (transrectal and transperineal).
- 55713 and 55714 – Codes for in-bore biopsies (done inside an MRI or CT machine bore with real-time guidance) for first targeted lesion.
- +55715 – An add-on code for each additional targeted lesion in an MRI/CT fusion or in-bore biopsy. (This means if multiple lesions are targeted, 55715 is used for the second, third, etc., in addition to the primary code.)
Why this change? The new codes better describe modern prostate biopsy techniques. They include whether the biopsy is done through the rectum or through the perineum, and whether imaging like ultrasound or MRI fusion is used. They also bundle the imaging guidance into the code, so you don’t bill separately for ultrasound or MRI guidance, it’s all included now. This change encourages comprehensive documentation because the urologist must note the approach and guidance used, which determines the correct code.
The above changes mean that urologists and coders must update superbills and EMR templates for 2026. Using a deleted code (like 55700 or 52647) on a claim in 2026 will result in denial. Instead, use the new codes where applicable. Also, because imaging is bundled into many of the new prostate codes, do not add separate CPT codes for ultrasound or MRI guidance for those procedures. Everything is included in one code to simplify billing.
Medicare Updates and Payer-Specific Considerations for 2026
Changes in CPT codes often go hand-in-hand with changes in Medicare billing rules and payer policies. Here are important 2026 Medicare updates and some payer-specific variations to note for urology coding:
Medicare’s Physician Fee Schedule (PFS) 2026:
Medicare released its final rule for 2026, which affects how much urologists get paid for these CPT codes. For the first time in several years, Medicare’s conversion factor (the basic dollar rate per RVU) is increasing slightly. However, Medicare also introduced an “efficiency adjustment” that reduces the Work RVUs for most procedures by 2.5%. This means even though the base rate is higher, many surgical procedures (including urology surgeries) have a bit lower value units. Net effect: Medicare estimates overall payments to urology in 2026 will be about 0% change (flat) compared to 2025. In other words, any increase in the conversion factor is canceled out by the RVU cuts and other adjustments, so urology practices shouldn’t expect a big jump in Medicare revenue.
Facility vs Office Impact:
Medicare adjusted how practice expenses are calculated. They are reducing indirect cost payments for procedures done in a facility (like a hospital or surgery center) and slightly increasing them for office-based services. The result is an estimated -10% payment for urology procedures in facility settings (less money for surgeries done in hospital or ASC), but about a +5% increase for office-based urology services. For example, if a urologist performs a procedure in the office, Medicare might pay a little more in 2026 than before, but if the same procedure is done in a hospital, Medicare’s portion to the doctor might be less. Urologists should be aware of this shift, as it could influence decisions about setting (though patient safety and medical necessity of setting remain top priorities).
Medicare Bundling of Services:
As discussed with the new biopsy codes, Medicare now bundles imaging guidance into those codes. All major payers usually follow this rule, meaning you shouldn’t bill things like ultrasound guidance (CPT 76942) separately when using the new bundled codes for prostate biopsy or ablation – regardless of the insurer. Always check CPT guidelines: for instance, 55877 (NanoKnife ablation) includes image guidance, and CPT explicitly says not to bill those guidance codes with it. Medicare will deny the extra guidance codes as unbundling.
Payer-Specific Coding Variations for Coding in 2026
Not all insurance payers handle codes exactly the same way as Medicare. Here are a few variations to keep in mind:
Bilateral procedures:
Medicare often has strict rules for bilateral coding. For example, if a urologist does a cystoscopy with ureteral catheterization on both the left and right ureters, Medicare says do not bill it twice – one unit of 52005 covers both sides. However, some private insurance companies might allow billing bilateral procedures with a modifier (like modifier 50 or LT/RT). Always verify each payer’s policy. For private payers, check if they want a bilateral modifier or separate line items for procedures done on both sides.
Category III codes coverage:
New technologies (like HIFU with code 0950T) may not be covered by all payers initially. Medicare might not reimburse a Category III code without evidence of its benefits. Some private payers or Medicare Advantage plans might require prior authorization for these new procedures. Urology practices should check coverage policies for Aquablation (52597) or HIFU (0950T) with different payers. In 2026, Aquablation has a Category I code, which Medicare has valued (with RVUs) and is more likely to be reimbursed, whereas HIFU for benign conditions is still Category III, which could be considered investigational by some insurers.
Documentation requirements:
Payers can have specific documentation needs. For example, to bill the new MRI-fusion biopsy codes, ensure the report clearly states that MRI fusion guidance was used and how many targeted lesions were biopsied. If this detail is missing, an auditor might question the use of those higher-level codes. This is not a different code per payer, but a difference in how strictly they enforce coding rules.
Medicare Update on Telehealth (FYI):
While not directly a CPT code issue for procedures, it’s worth noting that Medicare extended many telehealth flexibilities into 2026. Urology practices can still conduct telehealth E/M visits under certain rules. And remember, Medicare Advantage and private payers may have their own telehealth rules regardless of Medicare’s base policy. Always stay updated on these if your practice does virtual consultations, as coding for telehealth visits uses different Urology CPT codes or modifiers.
Bottom line for payers:
Medicare often sets the tone for coding and reimbursement, but always double-check if a private payer deviates. The 2026 Medicare fee schedule changes mean know your setting impacts, and the CPT updates mean use the new Urology CPT codes and retire the old ones. By staying informed, urologists can avoid claim denials and ensure they get paid appropriately for the care they provide.
Conclusion
Coding in urology might seem complicated, but it becomes manageable with an updated guide. This “Urology CPT Codes Guide 2026” has outlined the essential codes and changes that urologists need to know. We discussed common procedures like cystoscopy CPT codes, laparoscopic surgery codes (51990, 51992), and prostate surgery codes (like 52601 for TURP) in simple terms. We also highlighted the major CPT changes from 2025 to 2026, including new biopsy codes and advanced procedures, as well as Medicare’s latest rules that affect urology coding.
Always remember to use clear documentation and the exact code that matches the procedure. When in doubt about a code change or a payer’s rule, consult the 2026 CPT manual or official Medicare guidance. By staying informed about Urology CPT coding and updates, providers can focus on patient care while ensuring their billing is accurate and up-to-date. Here’s to a well-coded and successful 2026 in your urology practice!
