Summary & Overview
CPT 52402: Cystourethroscopy with Resection or Incision of Ejaculatory Ducts
CPT code 52402 is a key billing code for cystourethroscopy with transurethral resection or incision of ejaculatory ducts, a procedure commonly performed by urologists to treat obstructions or abnormalities in the ejaculatory ducts. This code is nationally recognized and utilized across a range of healthcare settings, particularly in surgical suites and urology operating rooms. The procedure is significant for its role in managing urinary and reproductive health, especially in cases involving calculi or other ductal issues.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and relevant benchmarks for this procedure. Readers will gain insight into policy updates, coding practices, and the clinical indications associated with CPT code 52402. The summary also highlights common modifiers and related codes, offering a comprehensive look at how this procedure is billed and reimbursed in the current healthcare landscape. This information is essential for understanding national trends in urology billing and the procedural standards for cystourethroscopy with resection or incision of ejaculatory ducts.
CPT Code Overview
CPT code 52402 describes a cystourethroscopy with transurethral resection or incision of ejaculatory ducts, a specialized urological surgical procedure. This service is typically performed in a urology operating room or surgical suite and is used to address conditions affecting the ejaculatory ducts, often related to urinary tract or prostate issues. The procedure involves the use of a cystoscope to visualize the urethra and bladder, followed by surgical intervention to resect or incise the ejaculatory ducts as clinically indicated.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult male presenting to a urology clinic with symptoms such as painful ejaculation, hematuria, or infertility. Diagnostic imaging reveals obstruction or calculi within the ejaculatory ducts. The urologist schedules a cystourethroscopy with transurethral resection or incision of the ejaculatory ducts (52402) in a surgical suite. The procedure is performed under anesthesia, allowing direct visualization and treatment of the ductal obstruction, often caused by calculi or strictures. Post-procedure, the patient is monitored for urinary function and potential complications.
Coding Specifications
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Modifiers:
- Modifier
51: Used when multiple procedures are performed during the same session. Indicates that52402is one of several procedures. - Modifier
59: Used to denote a distinct procedural service, such as when52402is performed separately from other procedures not typically performed together.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208800000X | Urology Physician |
2088P0231X | Pediatric Urology Physician |
2088F0040X | Female Pelvic Medicine and Reconstructive Surgery Physician |
These taxonomies represent providers specializing in urology, pediatric urology, and female pelvic medicine and reconstructive surgery, all of whom may perform or be involved in this procedure.
Related Diagnoses
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N20.0: Calculus of kidney- Relevant if kidney stones are present and contribute to urinary tract obstruction, potentially affecting ejaculatory ducts.
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N20.1: Calculus of ureter- Indicates ureteral stones, which may be associated with lower urinary tract symptoms requiring cystourethroscopy.
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N21.0: Calculus in bladder- Bladder stones can cause obstruction or symptoms that lead to evaluation and treatment of ejaculatory duct issues.
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N21.1: Calculus in urethra- Urethral stones may directly obstruct the ejaculatory ducts, making this diagnosis highly relevant to the procedure.
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N20.9: Urinary calculus, unspecified- Used when the location of the urinary stone is not specified but is implicated in the clinical scenario requiring
52402.
- Used when the location of the urinary stone is not specified but is implicated in the clinical scenario requiring
Related CPT Codes
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36000: Introduction of needle or intracatheter, vein- Used for establishing intravenous access, which is often required for anesthesia or medication administration during surgical procedures like
52402.
- Used for establishing intravenous access, which is often required for anesthesia or medication administration during surgical procedures like
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36410: Venipuncture, age 3 years or older, necessitating physician's skill (separate procedure)- May be performed for blood sampling or IV access in patients undergoing
52402, especially if difficult venous access is anticipated.
- May be performed for blood sampling or IV access in patients undergoing
These codes are commonly used together with 52402 as part of the perioperative workflow, but are not alternatives to the primary procedure.
National Reimbursement Benchmarks
UnitedHealth Group has the highest national mean rate for CPT code 52402 at $476.49, while Medicare's mean rate is significantly lower at $233.92. The average commercial mean rate, represented by BUCA, stands at $380.21, which is $146.29 higher than Medicare.
Rate dispersion varies notably across payers. Medicare shows the tightest range between the 75th and 25th percentiles ($14.00), indicating minimal variation in reimbursement. In contrast, UnitedHealth Group exhibits the widest range ($275.00), followed by Cigna ($238.00), reflecting greater variability in commercial payer rates. Aetna and Blue Cross Blue Shield have moderate dispersion, with ranges of $101.70 and $146.32, respectively.
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.