CPT 52204
Global 000 ActiveCystoscopy w/biopsy(s)
CPT 52204 Billing & Documentation Guide
CPT code 52204 (Cystoscopy w/biopsy(s)) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.53, a non-facility practice expense RVU of 7.77, and a malpractice RVU of 0.34, a total non-facility RVU of 10.64 and facility RVU of 3.8. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $366.8, though rates vary from $313.28 to $474.12 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 52204, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 52204 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 52204 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 52204
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.53 | 2.53 |
| Practice Expense RVU | 7.77 | 0.93 |
| Malpractice RVU | 0.34 | 0.34 |
| Total RVU | 10.64 | 3.8 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 52204
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $400.78 | $130.45 | $376.47 - $474.12 | 29 |
| Florida | $367 | $137.78 | $349.68 - $383.39 | 3 |
| Georgia | $345.81 | $127.86 | $329.54 - $362.07 | 2 |
| Illinois | $357.27 | $136.52 | $339.2 - $371.98 | 4 |
| Michigan | $344.18 | $129.66 | $334.27 - $354.09 | 2 |
| North Carolina | $333.9 | $120.74 | $333.9 - $333.9 | 1 |
| New York | $393.48 | $138.6 | $339.04 - $419.58 | 5 |
| Ohio | $332.9 | $124.31 | $332.9 - $332.9 | 1 |
| Pennsylvania | $351.61 | $127.83 | $333.48 - $369.74 | 2 |
| Texas | $351.02 | $126.1 | $331.22 - $369.31 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 52204
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 52204 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00910 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 00916 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0420U | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0596T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0597T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 52204
What does CPT code 52204 mean? +
CPT code 52204 represents: Cystoscopy w/biopsy(s). It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 52204? +
The 2026 Medicare national average non-facility payment for CPT 52204 is $366.8. Rates range from $313.28 to $474.12 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 52204? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 52204? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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