2021 BILLING AND CODING GUIDE UROLOGY SURGERY 2021 Medicare Physician, Hospital Outpatient, ASC Coding and Payment Rates listed in this guide are based on their respective site of care- physician office, ambulatory surgical center, or hospital outpatient department. All rates provided are for the Medicare National Average rounded to the nearest whole number for 2021 and do not represent adjustment specific to the provider's location or facility. Commercial rates are based on individual contracts. Providers are encouraged to review contracts to verify their specific contracted allowables. Medtronic products used associated with wound closure procedures addressed within this guide do not have dedicated HCPCS1 level II coding assignment. Providers may choose to report A4649 Surgical supply; miscellaneous for purposes of cost tracking. Medicare considers the use of surgical supplies to be included in the payment for the associated CPT and no additional payment is allowed. AMBULATORY HOSPITAL ® 2 CODE DESCRIPTION 3 SURGICAL CPT CODE PHYSICIAN OUTPATIENT4 CENTER (ASC)4 CYSTECTOMY 51550 Cystectomy, partial; simple Facility Only: $979 Inpatient only, not reimbursed for hospital outpatient or ASC 51555 Cystectomy, partial; complicated (eg, postradiation, Facility Only: $1,284 Inpatient only, not reimbursed for hospital previous surgery, difficult location) outpatient or ASC 51565 Cystectomy, partial, with reimplantation of ureter(s) Facility Only: $1,309 Inpatient only, not reimbursed for hospital into bladder (ureteroneocystostomy) outpatient or ASC 51570 Cystectomy, complete (separate procedure) Facility Only: $1,492 Inpatient only, not reimbursed for hospital outpatient or ASC 51575 Cystectomy, complete; with bilateral pelvic Facility Only: $1,847 Inpatient only, not reimbursed for hospital lymphadenectomy, including external iliac, outpatient or ASC hypogastric, and obturator nodes 51580 Cystectomy, complete, with ureterosigmoidostomy Facility Only: $1,925 Inpatient only, not reimbursed for hospital or ureterocutaneous transplantations outpatient or ASC 51585 Cystectomy, complete, with ureterosigmoidostomy Facility Only: $2,141 Inpatient only, not reimbursed for hospital or ureterocutaneous transplantations, with bilateral outpatient or ASC pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes 51590 Cystectomy, complete, with ureteroileal conduit or Facility Only: $1,962 Inpatient only, not reimbursed for hospital sigmoid bladder, including intestine anastomosis outpatient or ASC 51595 Cystectomy, complete, with ureteroileal conduit or Facility Only: $2,219 Inpatient only, not reimbursed for hospital sigmoid bladder, including intestine anastomosis; with outpatient or ASC bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes 51596 Cystectomy, complete, with continent diversion, any Facility Only: $2,390 Inpatient only, not reimbursed for hospital open technique, using any segment of small and/or outpatient or ASC large intestine to construct neobladder 1 AMBULATORY HOSPITAL ® 2 CODE DESCRIPTION 3 SURGICAL CPT CODE PHYSICIAN OUTPATIENT4 CENTER (ASC)4 NEPHRECTOMY 50220 Nephrectomy, including partial ureterectomy, any open Facility Only: $1,071 Inpatient only, not reimbursed for hospital approach including rib resection outpatient or ASC 50225 Nephrectomy, including partial ureterectomy, any open Facility Only: $1,221 Inpatient only, not reimbursed for hospital approach including rib resection; complicated because outpatient or ASC of previous surgery on same kidney 50230 Nephrectomy, including partial ureterectomy, any Facility Only: $1,301 Inpatient only, not reimbursed for hospital open approach including rib resection; radical, outpatient or ASC with regional lymphadenectomy and/or vena caval thrombectomy 50234 Nephrectomy with total ureterectomy and bladder cuff; Facility Only: $1,324 Inpatient only, not reimbursed for hospital through same incision outpatient or ASC 50236 Nephrectomy with total ureterectomy and bladder cuff; Facility Only: $1,489 Inpatient only, not reimbursed for hospital through separate incision outpatient or ASC 50240 Nephrectomy, partial Facility Only: $1,346 Inpatient only, not reimbursed for hospital outpatient or ASC 50543 Laparoscopy, surgical; partial nephrectomy Facility Only: $1,513 $3,794 $8,908 50545 Laparoscopy, surgical; radical nephrectomy (includes Facility Only: $1,357 Inpatient only, not reimbursed for hospital removal of Gerota's fascia and surrounding fatty tissue, outpatient or ASC removal of regional lymph nodes, and adrenalectomy) 50546 Laparoscopy, surgical; nephrectomy, including partial Facility Only: $1,224 Inpatient only, not reimbursed for hospital ureterectomy outpatient or ASC 50548 Laparoscopy, surgical; nephrectomy with total Facility Only: $1,366 Inpatient only, not reimbursed for hospital ureterectomy outpatient or ASC PROSTATECTOMY 55801 Prostatectomy, perineal, subtotal (including control of Facility Only: $1,113 Inpatient only, not reimbursed for hospital postoperative bleeding, vasectomy, meatotomy, urethral outpatient or ASC calibration and/or dilation, and internal urethrotomy) 55810 Prostatectomy, perineal radical Facility Only: $1,329 Inpatient only, not reimbursed for hospital outpatient or ASC 55812 Prostatectomy, perineal radical; with lymph node Facility Only: $1,632 Inpatient only, not reimbursed for hospital biopsy(s) (limited pelvic lymphadenectomy) outpatient or ASC 55815 Prostatectomy, perineal radical; with bilateral pelvic Facility Only: $1,788 Inpatient only, not reimbursed for hospital lymphadenectomy, including external iliac, hypogastric outpatient or ASC and obturator nodes 55821 Prostatectomy (including control of postoperative Facility Only: $889 Inpatient only, not reimbursed for hospital bleeding, vasectomy, meatotomy, urethral calibration outpatient or ASC and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages 2 AMBULATORY HOSPITAL ® 2 CODE DESCRIPTION 3 SURGICAL CENTER CPT CODE PHYSICIAN OUTPATIENT4 (ASC)4 55831 Prostatectomy (including control of postoperative Facility Only: $961 Inpatient only, not reimbursed for hospital bleeding, vasectomy, meatotomy, urethral calibration outpatient or ASC and/or dilation, and internal urethrotomy); retropubic, subtotal 55840 Prostatectomy, retropubic radical, with or without Facility Only: $1,188 Inpatient only, not reimbursed for hospital nerve sparing outpatient or ASC 55842 Prostatectomy, retropubic radical, with or without nerve Facility Only: $1,191 Inpatient only, not reimbursed for hospital sparing; with lymph node biopsy(s) (limited pelvic outpatient or ASC lymphadenectomy) 55845 Prostatectomy, retropubic radical, with or without nerve Facility Only: $1,382 Inpatient only, not reimbursed for hospital sparing; with bilateral pelvic lymphadenectomy, including outpatient or ASC external iliac, hypogastric, and obturator nodes 55866 Laparoscopy, surgical prostatectomy, retropubic radical, Facility Only: $1,464 $3,794 $8,908 including nerve sparing, includes robotic assistance, when performed ROBOTIC ASSISTANCE Surgical techniques requiring use of robotic surgical HCPCS II S-Codes cannot be reported to Medicare. They are S2900 system (list separately in addition to code for primary used only by non-Medicare payers, which may cover and price procedure) them according to their own requirements REFERENCES: 1Centers for Medicare & Medicaid Services. Alpha-numeric HCPCS. https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update 2CPT copyright 2020 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein 3Centers for Medicare & Medicaid Services. Medicare Program; CY 2021 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Quality Payment Program; Coverage of Opioid Use Disorder Services Furnished by Opioid Treatment Programs; Medicare Enrollment of Opioid Treatment Programs; Electronic Prescribing for Controlled Substances for a Covered Part D Drug; Payment for Office/Outpatient Evaluation and Management Services; Hospital IQR Program; Establish New Code Categories; Medicare Diabetes Prevention Program (MDPP) Expanded Model Emergency Policy; Coding and Payment for Virtual Check-in Services Interim Final Rule Policy; Coding and Payment for Personal Protective Equipment (PPE) Interim Final Rule Policy; Regulatory Revisions in Response to the Public Health Emergency (PHE) for COVID-19; and Finalization of Certain Provisions from the March 31st, May 8th and September 2nd Interim Final Rules in Response to the PHE for COVID-19; Final Rule, Federal Register (85 Fed. Reg. No. 248 84472- 85377) 42 CFR Parts 400, 410, 414, 415, 423, 424, and 425. https://www.govinfo.gov/content/pkg/FR-2020-12-28/pdf/2020- 26815.pdf. 4Centers for Medicare & Medicaid Services. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting