Urology ICD-10 Codes & CPT Codes

Accurate urology coding is critical for reimbursement and compliance. This reference covers the most-used ICD-10-CM diagnosis codes and CPT procedure codes for urology practices in the United States. Whether you are billing for BPH management, kidney stone treatment, or cystoscopy, these codes reflect current CMS ICD-10-CM guidelines for FY2026 (effective October 1, 2025) and AMA CPT 2026 procedure code updates, with select FY2027 ICD-10-CM codes (effective October 1, 2026) noted where already adopted.

FY 2027 ICD-10-CM (CMS, eff. 10/1/2026) · CPT 2026 (AMA) · All codes verified billable · Last verified: October 2026

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Top ICD-10 Codes for Urology

ICD-10 Code Description Billable
N40.0 Benign prostatic hyperplasia without lower urinary tract symptoms ✓
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms ✓
N40.3 Nodular prostate without lower urinary tract symptoms ✓
N20.0 Calculus of kidney ✓
N20.1 Calculus of ureter ✓
N20.2 Calculus of kidney with calculus of ureter ✓
N39.0 Urinary tract infection, site not specified ✓
N30.00 Acute cystitis without hematuria ✓
N30.01 Acute cystitis with hematuria ✓
R31.9 Hematuria, unspecified ✓
N13.30 Unspecified hydronephrosis ✓
N35.9 Urethral stricture, unspecified ✓
N32.9 Bladder disorder, unspecified ✓
C61 Malignant neoplasm of prostate ✓
C67.9 Malignant neoplasm of bladder, unspecified ✓
R33.9 Retention of urine, unspecified ✓
N41.1 Chronic prostatitis ✓
N44.00 Torsion of testis, unspecified ✓
N47.1 Phimosis ✓
N52.9 Male erectile dysfunction, unspecified ✓
N52.31 Erectile dysfunction following radical prostatectomy ✓
N39.3 Stress incontinence (female) (male) ✓
Q54.9 Hypospadias, unspecified ✓

Source: CMS ICD-10-CM Official Code Set FY 2026 · N52.31 reflects the FY2026 postprocedural erectile dysfunction expansion (effective Oct. 1, 2025).

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Common CPT Codes for Urology Billing

CPT Code Description Medicare Rate* Common Modifiers
52000 Cystourethroscopy (separate procedure) ~$215.77 -51, -59
52351 Cystourethroscopy with ureteroscopy, diagnostic N/A (facility) -59
52356 Cystourethroscopy with ureteroscopy and lithotripsy N/A (facility) -59, -RT/-LT
50590 Lithotripsy, extracorporeal shock wave ~$760 -RT/-LT
55707 Biopsy, prostate; transrectal, ultrasound-guided, systematic (replaces deleted 55700) ~$342 N/A
55708 Biopsy, prostate; transrectal, ultrasound-guided, with MRI-fusion targeting ~$420 N/A
55250 Vasectomy, unilateral or bilateral ~$346.70 -50
54150 Circumcision, using clamp or other device ~$151.97 N/A
51798 Measurement of post-voiding residual urine by ultrasound ~$12.69 -26, -TC
51741 Complex uroflowmetry ~$15.36 -26, -TC
51702 Insertion of temporary indwelling bladder catheter; simple ~$65.47 N/A
52630 Transurethral resection of residual or regrowth of prostate tissue N/A (facility) N/A
52597 Transurethral robotic-assisted waterjet resection of prostate (Aquablation), including cystourethroscopy and imaging guidance N/A (facility) N/A
76872 Ultrasound, transrectal ~$120.24 -26, -TC
99213 Office outpatient visit, established patient, low complexity ~$95.19 -25, -95
99214 Office outpatient visit, established patient, moderate complexity ~$135.61 -25, -95

*Approximate 2026 CMS national non-facility rate. N/A means Medicare pays this procedure only in a facility setting. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates. Effective January 1, 2026, CPT deleted 55700 (prostate biopsy, any approach) and replaced it with the imaging-specific 55705–55715 family; 52597 (Aquablation of the prostate) is new for CPT 2026.

Top Denial Reasons for Urology Claims

⚠

Medical Necessity Not Documented

Cystoscopy, urodynamics, and prostate biopsy require documented symptoms such as hematuria, LUTS, or an abnormal PSA supporting the clinical indication in the medical record before the procedure is billed.

⚠

Missing or Incorrect Modifier

Unilateral procedures such as kidney stone treatment (50590, 52356) are frequently denied when laterality modifiers -RT or -LT are omitted. Bilateral vasectomy (55250) similarly requires the -50 modifier when both sides are addressed in one session.

⚠

Prior Authorization Not Obtained

Many payers require prior authorization for extracorporeal shock wave lithotripsy (50590) and advanced imaging. Confirm payer-specific requirements and secure written approval before scheduling elective stone or prostate procedures.

⚠

Diagnosis-Procedure Code Mismatch

Claims are denied when a TURP-related code (52630) is billed without a supporting BPH-with-LUTS diagnosis (N40.1), or when a stone-removal procedure lacks a matching calculus diagnosis (N20.x). Cross-check NCCI edits before submission.

Coding a specific symptom in detail? ICD-10 Code for UTI ›

Urology Billing & Coding Tips

  • Distinguish BPH with lower urinary tract symptoms (N40.1) from BPH without symptoms (N40.0) — the LUTS distinction directly affects medical necessity for TURP and related procedures.
  • Code kidney and ureteral stones (N20.0, N20.1, N20.2) by exact location and laterality when documented in the operative note.
  • Cystourethroscopy (52000) is frequently bundled under NCCI edits with other same-session endoscopic procedures — verify edits before billing it separately.
  • Vasectomy (55250) billed under a contraception-only diagnosis is excluded from coverage by many payers — confirm payer policy before scheduling.

Frequently Asked Questions

What is the ICD-10 code for BPH?

Use N40.1 when lower urinary tract symptoms (LUTS) are documented, or N40.0 when BPH is present without LUTS. N40.3 applies to a nodular prostate without LUTS.

What CPT code is used for a cystoscopy?

52000 covers a diagnostic cystourethroscopy. If ureteroscopy is also performed, use 52351 (diagnostic) or 52356 (with stone treatment/lithotripsy) instead.

Is a kidney stone (N20.0) billable?

Yes. N20.0 (calculus of kidney) is a valid, billable ICD-10-CM code. Use N20.1 for ureteral stones or N20.2 when both are present.

How does OmniMD help with urology coding?

OmniMD’s EHR suggests ICD-10 and CPT codes directly in the encounter workflow, reducing manual lookup time and claim denial rates.

What is the difference between 52000 and 52351?

52000 is a diagnostic cystourethroscopy alone. 52351 adds diagnostic ureteroscopy in the same session. Use 52356 instead of 52351 if the ureteroscopy includes stone treatment.

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