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CODING TIPS & TRICKS Current Procedural Terminology Code Updates for 2025 of Interest to Urology
By: Jonathan Rubenstein, MD, Compliance Officer, United Urology Group, Current Procedural Terminology Advisor, AUA | Posted on: 30 Dec 2024
The Current Procedural Terminology (CPT) 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. For January 2025, Category I code updates include a new code for MRI-monitored transurethral ultrasound ablation of prostate tissue, procedures for cystoscopic placement, and for removing a temporary ischemic remodeling device of the prostate, a new code set for open tumor/mass excision, and the deletion of 3 rarely used CPT codes. Category III (emerging technologies) code updates include new codes for reporting renal histotripsy and cystoscopy with renal pelvic sympathetic denervation and for procedures involving cystoscopy with prostatic scaffold placement and removal. The descriptors and discussion of these code changes are provided next.
New Category I CPT Codes: MRI-Monitored Transurethral Ultrasound Ablation of Prostate Tissue
Three new CPT codes were approved for reporting procedures involving MRI-monitored transurethral ultrasound ablation (TULSA-Pro; Table 1). This procedure is currently indicated for the ablation of prostate cancer. MRI is a proven, established imaging modality for evaluating and monitoring transurethral ultrasound prostate tissue ablation represented by codes 55881 and 55882. Code 51721 would be reported by the provider who places the ablation transducer and endorectal cooling device (and suprapubic tube if indicated) for the procedure if a different provider is performing the ablation. CPT 55881 would be reported by a provider who is performing the ablation but not placing the transducers. Code 55882 would be reported by a provider who performs both the transducer and cooling device placement along with the ablation. Exclusionary parenthetical notes have been added, precluding the reporting of these codes with catheter placement and MRI imaging.
Table 1. New Category I Current Procedural Terminology Codes: MRI-Monitored Transurethral Ultrasound Ablation of Prostate Tissue
CPT code | Descriptor |
---|---|
51721 | Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed |
55881 | Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation |
55882 | … with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed |
Abbreviations: CPT, Current Procedural Terminology. |
New Category I CPT Codes: Temporary Ischemic Remodeling Device of the Prostate
Two new Category I CPT codes have been created (Table 2) for reporting the cystoscopic-guided insertion (53865) and noncystoscopic removal (53866) of a temporary device to remodel the bladder neck and prostate that uses pressure to create necrosis to relieve lower urinary tract symptoms secondary to benign prostate hyperplasia. The device that currently fits this category is the iTind device. Both of these CPT codes are 0-day global codes. Instructional parenthetical notes have been added to direct users to other procedures for reporting permanent urethral stent (CPT code 52282) and cystourethroscopy with the removal of the temporary device (CPT code 52310), the latter of which should be used for reporting the removal of the device if cystoscopy is needed to directly visualize and grasp the device for removal. These codes should not be used for reporting procedures involving a prostatic scaffold (codes 0941T-0943T), a temporary prostatic stent (CPT code 53855), or a permanent prostatic stent.
Table 2. New Category I Current Procedural Terminology Codes: Temporary Ischemic Remodeling Device of the Prostate
CPT code | Descriptor |
---|---|
53865 | Cystourethroscopy with insertion of a temporary device for ischemic remodeling (ie, pressure necrosis) of the bladder neck and prostate |
53866 | Catheterization with the removal of a temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate |
Abbreviations: CPT, Current Procedural Terminology. |
New Category I CPT Code(s): Open Excision or Destruction of Tumors or Cysts
Five new Category I codes have been created for reporting open excision or destruction of tumors or cysts (Table 3). These codes replace CPT codes 49203 to 49205, which will be deleted. Codes should be reported based on the additive maximum length of intra-abdominal (peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s), or cyst(s) excised or destroyed. Please note that these codes may be used by urologists and urologic oncologists for the excision and destruction of retroperitoneal tumors, even if these masses are within lymph nodes and should be differentiated from the performance of a retroperitoneal lymph node dissection, which should be used when not specifically removing masses.
Table 3. New Category I Current Procedural Terminology Code(s): Open Excision or Destruction of Tumors or Cysts
CPT code | Descriptor |
---|---|
49186 | Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), the sum of the maximum length of tumor(s) or cyst(s) 5 cm or less |
49187 | …5.1-10 cm |
49188 | …10.1-20 cm |
49189 | …20.1-30 cm |
49190 | …>30 cm |
Abbreviations: CPT, Current Procedural Terminology. |
Deleted and Revised Category I Codes
CPT codes 50135, 54438, and 51030 (descriptions listed in Table 4) have been deleted from the 2025 CPT code set due to low data utilization of these services. In response, CPT code 51020 has been revised with the removal of the semicolon from the descriptor because it is no longer a parent code to 51030, which has been deleted.
Table 4. Deleted and Revised Category I Codes
CPT code | Action | Descriptor |
---|---|---|
50135 | Deleted Category I code | Pyelotomy; complicated (eg, secondary operation, congenital kidney abnormality) |
54438 | Deleted Category I code | Replantation, penis, complete amputation including urethral repair (To report replantation of incomplete penile amputation, see 54437 for the repair of corporeal tear[s] and 53410, 53415 for the repair of the urethra.) |
51030 | Deleted Category I code | Cystotomy or cystostomy, with cryosurgical destruction of intravesical lesion |
51020 | Revised Category I code | Cystotomy or cystostomy, with fulguration and/or insertion of radioactive material |
Abbreviations: CPT, Current Procedural Terminology. |
New Category III Codes
Histotripsy of malignant renal tissue
There is a new Category III code for reporting histotripsy of malignant renal tissue (Table 5). Histotripsy is a noninvasive, nonthermal, and nonionizing method treatment modality that uses short-duration, high-negative pressure focused ultrasound pulses to mechanically destroy tissue at the cellular level through controlled acoustic cavitation. This technique differs from high-intensity focused ultrasound, which uses continuous or long bursts of ultrasound at moderately high intensity. This code descriptor includes imaging guidance as needed to perform the procedure. The early release date was December 2023, with an effective date of July 1, 2024, for reporting this code.
Table 5. New Category III Codes
CPT code | Descriptor |
---|---|
0888T | Histotripsy (ie, nonthermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance |
0935T | Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), and fluoroscopy, bilateral |
0941T | Cystourethroscopy, flexible; with insertion and expansion of prostatic urethral scaffold using integrated cystoscopic visualization |
0942T | … with the removal and replacement of the prostatic urethral scaffold |
0943T | … with the removal of the prostatic urethral scaffold |
Abbreviations: CPT, Current Procedural Terminology. |
Cystourethroscopy with renal pelvic sympathetic denervation, frequency ablation, retrograde
A new Category III code, 0935T, has been established to report a new endoscopic transurethral approach to renal nerve denervation (Table 5). Code 0935T was included in the early released Category III codes on July 1, 2024, with an effective date of January 1, 2025. The existing procedure codes (52000, 52005, 52007) use catheter-based renal denervation administered through the renal artery (ie, transarterial approach), which differs from the new code using the transurethral approach.
Prostatic urethral scaffold procedures
Three new Category III codes (0941T-0943T) have been established for reporting the cystoscopic placement, removal and replacement, and removal of a prostatic urethral scaffold (Table 5). This technique is clinically different than the existing techniques and devices, and these code additions reflect the new procedures that are not currently identified with a specific CPT code and are performed via flexible cystourethroscopy. On July 1, 2024, codes 0941T to 0943T were released on the American Medical Association website, with an effective date of January 1, 2025. Since the establishment of these codes, it is inappropriate to report a Category I unlisted code for these services.
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