Urology billing
Urology billing services
We handle billing for urology practices, from office cystoscopy and urodynamics to prostate biopsies, stone procedures and in-office drug administration. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Global surgical periods tracked so post-op visits and new problems are billed right
- Urodynamics and in-office procedures coded as a complete set
- In-office drugs like leuprolide and BCG billed with units and admin codes
Why urology billing is different
Urology is part office, part surgery, part pharmacy
Urology practices bill E/M visits, in-office procedures, surgery with global periods and expensive drugs. The rules for each overlap on the same patients.
Global surgical periods
Many urology procedures carry a 0, 10 or 90-day global period. Visits inside that window are included unless they are for an unrelated problem (modifier 24) or a separate decision for surgery (modifier 57), and repeat procedures need modifiers such as 58, 78 or 79.
Cystoscopy with other services
Diagnostic cystoscopy is included in surgical cystoscopy. Tumor resection is coded by size, and stent placement, ureteroscopy and lithotripsy each have their own rules for what can be billed together.
Urodynamics as a set
A urodynamic study is usually several codes: cystometrogram, uroflowmetry, voiding pressure and EMG. Some are add-ons and must be billed with a primary code. Missing one leaves money on the table.
Prostate biopsy and imaging
Biopsy, ultrasound guidance and any MRI fusion work are coded separately. The number of cores and imaging used must be documented, and payers have their own pathology and guidance rules.
In-office drugs
Hormone therapy for prostate cancer and bladder instillations like BCG are billed with an administration code plus the drug in units. They often need prior authorization and wastage reporting.
Non-covered services
Vasectomy, some men’s health services and certain procedures are not covered by every plan. We check benefits first so the practice can collect or get a signed waiver where allowed.
Common codes
Urology codes we review before every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 52000 | Diagnostic cystourethroscopy | Not billed with surgical cystoscopy on the same session |
| 52234 / 52235 / 52240 | Bladder tumor resection (small, medium, large) | Tumor size documented in the operative note |
| 52332 / 52356 | Cystoscopy with ureteral stent; ureteroscopy with lithotripsy and stent | Laterality, bundling and global period |
| 55700 + 76872 | Prostate biopsy with transrectal ultrasound | Cores and guidance documented; payer rules for add-on imaging |
| 51726–51729 / 51741 / 51797 | Cystometrogram, uroflowmetry, voiding pressure add-on | Add-ons billed with the right primary code |
| 51798 | Post-void residual by ultrasound (bladder scan) | Medical necessity; not billed with a full pelvic ultrasound |
| 96402 + J9217 / 51720 + J9030 | Hormonal injection with leuprolide; bladder instillation with BCG | Authorization, drug units, NDC and JW/JZ modifier |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
The urology denials we stop before they happen
Most urology denials come from global periods, bundling and drugs. We check each one at charge entry.
- Visits during a global period denied because modifier 24, 25 or 57 was missing
- Staged or related procedures denied for missing modifier 58, 78 or 79
- Diagnostic cystoscopy billed with a surgical cystoscopy on the same day
- Urodynamic add-on codes billed without their primary code
- Drug claims with wrong units, missing NDC or missing authorization
- Laterality errors on stent and stone procedures
- Non-covered services billed without checking benefits or getting a waiver
What we handle
Everything between the visit and the payment
Our core focus is behavioral health. We bill urology practices with the same team, the same process and the same promises.
- Insurance eligibility, benefits and prior authorization checks before visits and procedures
- Charge entry and coding review of E/M, procedure, urodynamic and drug codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for every provider
- Patient statements and balance tracking (patient calls go to your office or an optional RevenueCTRL virtual assistant)
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for urology practices
Billing starts at 2.5% of collections, or a flat monthly fee. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing. No setup fee and no long-term contract.
Common questions
Can we bill an office visit on the same day as a cystoscopy?
Sometimes. Diagnostic cystoscopy has a 0-day global period, so the visit is billable only when it covers a significant, separate problem or the decision to do the procedure goes beyond the usual pre-procedure work. We bill it with modifier 25 when the note supports it.
How do you bill urodynamics?
We bill each component that was performed, such as the cystometrogram, uroflowmetry, voiding pressure and EMG, and make sure add-on codes are paired with their primary code. The report needs to show each component.
Do you bill leuprolide and BCG given in the office?
Yes. We bill the administration code and the drug code in the correct units, add the NDC where required and report wastage with modifier JW or JZ. We also confirm prior authorization before the treatment date.
How do you handle visits during a 90-day global period?
We check every visit against the global period of the last procedure. Routine post-op care is included, while an unrelated problem is billed with modifier 24 and a related return to the operating room with modifier 78.
Is vasectomy billed to insurance?
It depends on the plan. Some plans cover it and some do not. We check benefits before the procedure so your office can collect from the patient or get a signed waiver where the payer allows it.
How fast do you reply to questions?
A real person replies to calls and emails within 1 hour during business hours, Monday to Friday, 9am to 6pm Eastern.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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