The CPT (Current Procedural Terminology) code set undergoes annual updates on January 1 of each calendar year. It is crucial for urologists to stay informed about the changes that may impact their practice. Notable CPT code updates of interest to urology taking effect on January 1, 2024, are listed in Table 1. Category I code updates includes revisions to sacral nerve generator/receiver procedures, a new code for cystoscopy with urethral dilation and therapeutic drug delivery, and a new code for female pelvic exam. Category III code updates include new codes for reporting open integrated tibial nerve stimulator procedures for bladder dysfunction, multiday home uroflow, and penile shock wave therapy. The descriptors and discussion of these code changes are provided below.

Table 1. New, Revised, and Deleted Category I and Category III Current Procedural Terminology Codes of Interest to Urology Starting January 1, 2024

Revised Category I CPT Codes: Sacral Nerve Generator or Receiver Procedures

Old descriptors (used for dates of service before January 1, 2023):

CPT 64590: Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling

CPT 64595: Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver

Revised descriptors (changes in bold; used for dates of service on or after January 1, 2024):

CPT 64590: Insertion or replacement of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or receiver.

CPT 64595: Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array

Discussion: Neurostimulator technology is constantly advancing. Neurostimulator procedures include components such as stand-alone arrays and stand-alone generators or receivers (often then attached to an array), and now integrated devices which include a generator or receiver with an attached or internal array. Devices or components may be placed by open or percutaneous surgical approaches. Table 2 lists the neurostimulator devices, procedures, and associated CPT codes of interest to urology that are available to report as of January 1, 2024.

Table 2. Neurostimulator Devices, Procedures, and Associated Current Procedural Terminology Codes of Interest to Urology That Are Available to Report as of January 1, 2024

For urology, CPT codes 64590 and 64595 are used to report the insertion/replacement and revision/removal, respectively, of a sacral neurostimulator generator or receiver that is attached to a separately placed electrode array. To clarify the reporting details, CPT codes 64590 and 64595 were revised for January 1, 2024, by adding the word “sacral” to the descriptor and by replacing the term “direct or inductive coupling” with “connection between array and pulse generator and receiver.” Therefore CPT code 64590 should be reported for placement of the generator/receiver whether placed concomitant with the separate electrode array (reported with code 64561 for percutaneous placement of the array) and attached, or at a separate encounter using a previously placed array. It is important not to report these codes for the placement or revision/removal of integrated (generator or receiver with an attached or integral array) neurostimulator systems. The updated parentheticals for code 64590 provide instruction not to report with code 64595 or in conjunction with new Category I codes for integrated peripheral nerve stimulation procedures (codes 64596 through 64598).

Codes 64590 and 64595 were revalued, and the work relative value unit (RVU) values updated to 5.10 for code 64590 and 3.79 for code 64595.

New Category I CPT Code: Female Pelvic Exam

Code Descriptor:

CPT 99459: Female pelvic exam (list separately in addition to code for primary procedure)

Discussion: CPT 99459 is a practice expense only code (no work RVU) that captures the direct practice expenses associated with performing a female pelvic exam in the nonfacility setting at the time of an evaluation and management service (CPT codes 99202-99205, 99212-99215) or preventive medicine services (codes 99381-99397). Expenses captured include equipment such as a speculum and drapes, and 4 minutes of clinical staff time associated with chaperoning the exam. The work RVU is included with the evaluation and management code billed for the visit.

New Category I Code: Cystourethroscopy With Balloon Dilation and Drug Delivery

Code Descriptor:

CPT 52284: Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male, including fluoroscopy, when performed

Discussion: The new Category I code 52284 replaces the (to be deleted) Category III code 0499T, Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed. This code is used to report cystourethroscopy with mechanical urethral dilation of a urethral stricture with urethral therapeutic drug delivery. The work RVU for the procedure is 3.10 and it has a 0-day global period. The procedure includes cystoscopy, urethral dilation, and fluoroscopy, so CPT codes 52000, 52281, 52283, 74450, and 76000 are not reported separately.

It is important to not confuse this urethral dilation procedure with a similar (albeit unique balloon) prostate dilation with drug delivery procedure reported using Category III CPT code 0619T, Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed. Similarly, it would be inappropriate to report CPT code 52284 for prostate balloon dilation with drug delivery.

New and Revised Category III Codes: Tibial Nerve Neurostimulator Procedures

New Codes and Descriptors:

CPT 0816T: Open insertion or replacement of integrated neurostimulation system for bladder dysfunction including electrode(s) (eg, array or leadless), and pulse generator or receiver, including analysis, programming, and imaging guidance when performed, posterior tibial nerve; subcutaneous

CPT 0817T: Open insertion or replacement….subfascial

CPT 0818T: Revision or removal…. subcutaneous

CPT 0819T: Revision or removal….subfascial

Discussion: Four new Category III codes have been introduced for reporting open procedures for tibial nerve stimulation for patients with bladder dysfunction: open subcutaneous placement/replacement, open subfascial placement/replacement, open revision or removal of a subcutaneous device, and open revision or removal of a subfascial device. Examples of subcutaneous devices include the eCoin device (Valencia Technologies) and Medtronic’s implantable tibial neuromodulation device, while an example of a subfascial device is the Revi device (BlueWind). It is important to differentiate the reporting of these devices using an open approach differs from that of integrated percutaneous devices targeting the tibial nerve that are reported using currently existing Category III codes 0587T and 0588T.

CPT 0587T: Percutaneous implantation or replacement of integrated single device neurostimulation system for bladder dysfunction including electrode array and receiver or pulse generator, including analysis, programming, and imaging guidance when performed, posterior tibial nerve

CPT 0588T: Revision or removal

Parentheticals are noted that instruct one not to report codes 0816T through 0819T in conjunction with codes 64555, 64566, 64575, 64590, 64596, 95970, 95971, 95972, 0588T, 0589T, and 0590T.

Programming these devices on the day of the procedure is included. For electronic analysis with programming of integrated or leadless neurostimulation system for bladder dysfunction, posterior tibial nerve, performed on a day subsequent to the device insertion, replacement, or revision, use codes 0589T and 0590T for simple (1-3 parameters) and complex (4 or more parameters) programming respectively

CPT 0589T: Electronic analysis with simple programming of implanted integrated neurostimulation system for bladder dysfunction (eg, electrode array and receiver)… posterior tibial nerve, 1-3 parameters

CPT 0590T: … 4 or more parameters

Note that codes 0589T and 0590T are used to report programming for either an open or percutaneous device targeting the tibial nerve.

New Category III Codes: Sacral Neurostimulator Procedures

Code Descriptors:

CPT 0786T: Insertion or replacement of percutaneous electrode array, sacral, with integrated neurostimulator, including imaging guidance, when performed

CPT 0788T: Revision or removal …

CPT 0789T: Electronic analysis with simple programming of implanted integrated neurostimulation system (eg, electrode array and receiver)… spinal cord or sacral nerve, 1-3 parameters

CPT 0790T: …4 or more parameters

Discussion: Four new Category III codes for reporting the percutaneous insertion/replacement or revision/removal of an integrated sacral neurostimulator. These codes should not be reported for the placement of an array alone targeting the sacral nerve (reported using CPT code 64561), a generator/receiver alone (CPT code 64590), or for the concomitant placement of an array and a generator/receiver. Similarly, CPT codes 64561 and 64590 should not be used to report the percutaneous placement of an integrated sacral neurostimulator. Although some may argue that the sacral nerve is a peripheral nerve, it would be incorrect to report CPT codes 64596 through 64598 (integrated peripheral nerve stimulation procedures) for integrated sacral nerve stimulation procedures.

New Category III CPT Codes: Remote Multiday Complex Uroflow

Code Descriptors:

CPT 0811T: Remote multiday complex uroflowmetry (eg, calibrated electronic equipment); setup and patient education on use of equipment

CPT 0812T: Device supply with automated report generation, up to 10 days

Discussion: In 2024 there will be 2 new Category III codes used to report remote multiday complex uroflowmetry; one code is for reporting educating the patient on the use of the equipment, and the other is for reporting device supply with report generation. The parentheticals instruct one not to report code 0812T for more than once per episode of care, and that these codes should not be reported with CPT codes 51741 (complex uroflow), 99453, and 99454 (remote patient monitoring codes). Similarly, parentheticals have been added following codes 99453, 99454, 51736 (simple uroflowmetry), and 51741 to preclude the reporting of these services with remote multiday uroflowmetry.

New Category III CPT Code: Penile Shock Wave Therapy

Code Descriptor:

CPT 0864T: Low-intensity extracorporeal shock wave therapy involving corpus cavernosum, low energy

Discussion: This new code was established to report the performance of low-intensity extracorporeal shock wave therapy to the corpus cavernosum. This procedure is indicated in men with erectile dysfunction. The parenthetical instructs one not to report code 0864T in conjunction with code 0101T (extracorporeal shock wave involving musculoskeletal system, not otherwise specified) when treating the same area.