CPT 52597
Global 090 ActiveTrurl rbtc wtrjt rescj prst8
CPT 52597 Billing & Documentation Guide
CPT code 52597 (Trurl rbtc wtrjt rescj prst8) is classified under Surgery (Urinary/Reproductive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 10.25, a non-facility practice expense RVU of 4.85, and a malpractice RVU of 1.32, a total non-facility RVU of 16.42 and facility RVU of 16.42. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $556.16, though rates vary from $504.22 to $710.36 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 52597, 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 current NCCI edits before bundling with related codes.
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 52597 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 52597
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 10.25 | 10.25 |
| Practice Expense RVU | 4.85 | 4.85 |
| Malpractice RVU | 1.32 | 1.32 |
| Total RVU | 16.42 | 16.42 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 52597
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 | $570.22 | $570.22 | $549.36 - $637.25 | 29 |
| Florida | $590.72 | $590.72 | $563.49 - $622.5 | 3 |
| Georgia | $550.17 | $550.17 | $539.41 - $560.92 | 2 |
| Illinois | $584.34 | $584.34 | $559.17 - $608.74 | 4 |
| Michigan | $556.53 | $556.53 | $540.04 - $573.02 | 2 |
| North Carolina | $521.67 | $521.67 | $521.67 - $521.67 | 1 |
| New York | $599.25 | $599.25 | $527.25 - $638.76 | 5 |
| Ohio | $534.7 | $534.7 | $534.7 - $534.7 | 1 |
| Pennsylvania | $551.25 | $551.25 | $532.73 - $569.76 | 2 |
| Texas | $544.68 | $544.68 | $530.73 - $566.63 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
Frequently Asked Questions, CPT 52597
What does CPT code 52597 mean? +
CPT code 52597 represents: Trurl rbtc wtrjt rescj prst8. It's in the Surgery (Urinary/Reproductive) category with a global period of 090.
What is the Medicare reimbursement for CPT 52597? +
The 2026 Medicare national average non-facility payment for CPT 52597 is $556.16. Rates range from $504.22 to $710.36 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 52597? +
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 52597? +
No NCCI PTP edits currently on file for this code.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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