Urology CPT® Codes for 2026 + Modifiers

Keep up-to-date with the latest CPT codes and modifiers for urology

Read Time: 2 minutes
Jan 2, 2026

Urology billing covers everything from routine office visits to diagnostic cystoscopy and high-dollar surgeries—often in the same episode of care. That variety is exactly why consistent documentation, clean coding, and smart modifier use matter so much in 2026. If your team is still working from last year’s favorites list, this update will help you align your most common urology CPT® codes and modifiers for 2026 with today’s coding landscape.

If you want a deeper revenue-cycle view (beyond codes), explore dedicated urology medical billing services.

Denials in urology usually aren’t “random”—they’re caused by predictable coding and documentation gaps.

We see the same issues repeatedly: claims kicked back for same-day E/M + procedures, incomplete documentation supporting medical necessity, and invalid-code rejections when teams keep using last year’s codes. We know where payers push back—and how to fix it fast.

Guarantee: We’ll identify the top denial causes in your urology claims and give you a clear plan to stop them.

Get My Urology Denial Snapshot

Evaluation and Management Codes Common in Urology

Most urology encounters start (and often end) with E/M services. Even when a procedure occurs on the same date, payers expect E/M documentation to clearly stand on its own if it is billed separately.

CPT® Code	Description
99202–99205	New patient office/outpatient visits (levels 2–5)
99212–99215	Established patient office/outpatient visits (levels 2–5)
99221–99223	Initial hospital inpatient or observation care
99231–99233	Subsequent hospital inpatient or observation care

Document the “Why Today”

Tip: When an office visit and a procedure occur on the same date, clearly separate the assessment and plan from the procedure note to support modifier use.

Getting paid for E/M in urology is hard when payers think it’s “bundled” into the procedure.

We see denials when 99213–99215 (or 99202–99205) are billed with common procedures and the documentation doesn’t clearly justify a separate, significant service—especially when modifier -25 is used. We know the wording and structure payers look for, and where documentation typically fails.

Guarantee: We’ll pinpoint exactly why your E/M claims are denied and show you what to change so the next batch pays.

Analyze My E/M + Procedure Denials

Contact us to get a Denial Snapshot highlighting E/M + procedure denial drivers and the fixes that restore reimbursement.

Common Urology Office Procedures and Endoscopy Codes

This table highlights high-frequency office and endoscopic procedures that often drive denials when documentation or modifiers are incomplete.

CPT® Code	Description
51701	Insertion of non-indwelling bladder catheter
51702	Insertion of temporary indwelling catheter (simple)
51703	Insertion of temporary indwelling catheter (complicated)
51798	Post-void residual measurement
52000	Diagnostic cystourethroscopy (cystoscopy)
52204	Cystoscopy with biopsy
52224	Cystoscopy with fulguration or treatment of minor lesion
54150	Circumcision using clamp or device

Critical Update: As of January 1, 2026, CPT® 55700 has been deleted and can no longer be billed. It has been replaced by a more granular family of prostate biopsy codes (55707–55715) that bundle imaging guidance and distinguish between systematic and targeted approaches.

If your cystoscopy claims aren’t paying, it’s usually a documentation/modifier issue—not the code itself.

We routinely see payer edits and denials around 52000, 52204, and 52224 when documentation doesn’t clearly support the indication, distinct services, or when a “distinct procedural service” is implied but not supported. And in 2026, using deleted 55700 will trigger immediate invalid-code rejections. We know the common pitfalls—and how to prevent them before they hit your AR.

Guarantee: We’ll find the exact reasons these claims aren’t paying and provide a fix plan you can implement immediately.

Fix My Cystoscopy Denials

Urology Diagnostic Testing CPT® Codes To Know

Diagnostic testing is a frequent denial trigger in urology, particularly when medical necessity or prior conservative management is not clearly documented.

CPT® Code	Description
81002	Urinalysis, non-automated (without microscopy)
81003	Urinalysis, automated (without microscopy)
51741	Complex uroflowmetry
51784	EMG studies of anal or urethral sphincter
51727	Complex cystometrogram
76856	Pelvic ultrasound, complete
76857	Pelvic ultrasound, limited or follow-up

Diagnostic testing denials happen when payers don’t see medical necessity—so they don’t pay.

For tests like 51741, 51727, 51784, and even imaging like 76856/76857, we commonly see denials tied to missing indications, incomplete symptom documentation, or lack of prior conservative management in the note. We know the patterns payers use to deny these services and what documentation makes claims defensible.

Guarantee: We’ll identify the top medical-necessity denial triggers in your testing claims and show you how to correct them.

Review My Testing Denials

Contact us to receive a Denial Snapshot that pinpoints why your urology diagnostic tests aren’t getting paid—and how to fix it.

Common Surgical Procedures and 2026 New Standards

The 2026 CPT® set includes the transition of Aquablation to a Category I code and a complete restructuring of prostate biopsy reporting.

CPT® Code	Description
52597	New: Aquablation (Category I replacement for 0421T)
55707	New: Prostate biopsy, transrectal ultrasound-guided; systematic
55708	New: Prostate biopsy, transrectal ultrasound-guided; systematic with MRI–ultrasound fusion targeted lesion work
55709	New: Prostate biopsy, transperineal ultrasound-guided; systematic
55715	Add-on: each additional targeted lesion (MRI–US fusion or in-bore CT/MRI guidance)
52356	Cystoscopy with ureteroscopy and laser lithotripsy
50590	Extracorporeal shock wave lithotripsy (ESWL)
52332	Cystoscopy with ureteral stent placement
52601	Transurethral resection of prostate (TURP)
54163	Repair of incomplete circumcision (recircumcision)
55250	Vasectomy

High-dollar urology claims hurt the most when they deny—because every day unpaid is real revenue at risk.

We see denials and payer requests spike when teams don’t fully transition from 0421T → 52597, or when prostate biopsy documentation doesn’t clearly support the new family (55707–55715)—especially systematic vs targeted, transrectal vs transperineal, and how many targeted lesions were performed for 55715. We know exactly what payers ask for and what gets these paid.

Guarantee: We’ll uncover what’s blocking reimbursement on your high-dollar claims and give you a step-by-step fix plan.

Check My High-Dollar Claims

A Quick 2026 “Watch List” for Urology Teams

The deletion of 55700 is the most impactful coding change for 2026. Practices should also ensure they have transitioned from the Category III “T” code (0421T) to the Category I code (52597) for Aquablation. Using deleted codes like 55700 will trigger invalid-code rejections, and failing to adopt the new prostate biopsy code family can increase denials and payer requests for additional documentation.

If your team misses just one 2026 change, payers will reject the claim—and you’ll be stuck reworking it.

We routinely see practices lose time and cash flow due to preventable rejections like billing deleted 55700 or staying on 0421T when 52597 is required. Those aren’t “hard denials”—they’re avoidable workflow breakdowns. We know how to catch them before they hit claims submission.

Guarantee: We’ll identify the exact 2026 code-transition risks in your billing workflow and show you how to eliminate them.

Check My 2026 Code Risk

Urology Billing Modifiers That Prevent Denials

Modifier	When It’s Commonly Used
-25	Separately identifiable E/M on the same day as a procedure
-59	Distinct procedural service (use carefully; payer edits apply)
-76	Repeat procedure by the same provider
-LT / -RT	Laterality for procedures involving paired organs
-52	Reduced services
-50	Bilateral procedure (payer rules vary)
-78	Unplanned return to the operating or procedure room
-79	Unrelated procedure during the post-operative period

Modifiers are where urology claims go to die—especially -25 and -59.

We see payers deny claims when -25 is appended without a clearly separable E/M “story,” or when -59 is used in situations payer edits won’t allow. Laterality (LT/RT) and bilateral rules (-50) can also cause denials when payer-specific rules aren’t followed. We know which modifier mistakes repeatedly block payment—and how to correct them.

Guarantee: We’ll identify your top modifier-driven denials and tell you exactly what to change to prevent repeat denials.

Analyze My Modifier Denials

Common ICD-10-CM Codes Used in Urology

ICD-10 Code	Description
N40.0	Benign prostatic hyperplasia (without LUTS)
N20.0	Calculus of kidney (kidney stone)
R32	Unspecified urinary incontinence
N39.0	Urinary tract infection, site not specified
C61	Malignant neoplasm of prostate
R31.9	Hematuria, unspecified
Z12.5	Encounter for screening for malignant neoplasm of prostate

A “right CPT®” can still deny if the diagnosis doesn’t support medical necessity.

We see denials when ICD-10 selection doesn’t align with payer policy—especially around hematuria (R31.9), stones (N20.0), BPH (N40.0), and screening-related visits (Z12.5). Medical-necessity mismatches are a silent AR killer because they look “coded” but won’t pay. We know how payers evaluate these pairings.

Guarantee: We’ll identify your most common CPT®/ICD mismatches and provide fixes that reduce medical-necessity denials.

Review My CPT/ICD Denials

Urology Billing Tips for 2026

Retire 55700. Ensure clinical and billing templates are updated to the new biopsy code family.
Separate the story. Standalone E/M documentation is essential when billing alongside procedures.
Update Aquablation coding. Use 52597 for 2026 claims instead of 0421T.
Validate biopsy approach. Documentation must clearly support transrectal vs. transperineal technique and targeted lesions.

If these “simple tips” aren’t built into your workflow, denials keep coming back—month after month.

Most teams know the rules, but denials persist because templates, charge capture, and documentation habits don’t match what payers require for 2026—especially around 55707–55715, same-day E/M + procedure billing, and Aquablation (52597). We help practices turn these rules into repeatable processes that get claims paid.

Guarantee: We’ll deliver a Denial Snapshot that identifies the exact process gaps causing denials—and a plan to fix them.

Get My Workflow Fix Plan

Contact us to receive a Denial Snapshot that turns your denial patterns into a clear action plan for higher reimbursement.

Final Thoughts

Keeping your urology CPT® codes and modifiers for 2026 current helps protect reimbursement, reduce denials, and keep your practice audit-ready. Building an annual code review into your workflow ensures billing accuracy as CPT® standards continue to evolve.

If you’re still chasing urology denials, you’re losing revenue and time you’ll never get back.

Whether your pain is same-day E/M + procedures, modifier misuse, diagnosis support, or the new 2026 transitions (55700 deletion, 52597, 55707–55715), we’ve seen these exact problems across urology and know how to correct them quickly.

Guarantee: We’ll identify your top denial causes and give you a concrete plan to fix them—so you can get paid.