CPT 52235
Global 000 ActiveCystoscopy and treatment
CPT 52235 Billing & Documentation Guide
CPT code 52235 (Cystoscopy and treatment) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.3, a non-facility practice expense RVU of 1.64, and a malpractice RVU of 0.68, a total non-facility RVU of 7.62 and facility RVU of 7.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $257.25, though rates vary from $235.78 to $336.39 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 52235, 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 52235 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 52235 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 52235
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.3 | 5.3 |
| Practice Expense RVU | 1.64 | 1.64 |
| Malpractice RVU | 0.68 | 0.68 |
| Total RVU | 7.62 | 7.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 52235
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 | $260.5 | $260.5 | $252.24 - $287.66 | 29 |
| Florida | $276.2 | $276.2 | $263.53 - $291.49 | 3 |
| Georgia | $256.73 | $256.73 | $252.96 - $260.49 | 2 |
| Illinois | $273.98 | $273.98 | $262.54 - $285.44 | 4 |
| Michigan | $260.43 | $260.43 | $252.68 - $268.18 | 2 |
| North Carolina | $242.65 | $242.65 | $242.65 - $242.65 | 1 |
| New York | $277.4 | $277.4 | $245.03 - $295.66 | 5 |
| Ohio | $249.93 | $249.93 | $249.93 - $249.93 | 1 |
| Pennsylvania | $256.55 | $256.55 | $248.77 - $264.33 | 2 |
| Texas | $253.02 | $253.02 | $247.97 - $264.09 | 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 52235
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 52235 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 |
| 00912 | 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 |
Frequently Asked Questions, CPT 52235
What does CPT code 52235 mean? +
CPT code 52235 represents: Cystoscopy and treatment. It's in the Surgery (Urinary/Reproductive) category with a global period of 000.
What is the Medicare reimbursement for CPT 52235? +
The 2026 Medicare national average non-facility payment for CPT 52235 is $257.25. Rates range from $235.78 to $336.39 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 52235? +
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 52235? +
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 June 2, 2026.
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