Stop Losing Revenue to Urology Billing Complexity
Certified urology billing specialists handling coding, denial management, and A/R follow-up for cystoscopy, biopsy, stone, and surgical claims — built around 2026 coding changes and NCCI bundling rules. Starting at 2.99%. Live in 7 days.
- Up to 98% first-pass claim acceptance
- AAPC-certified coders for cystoscopy, biopsy & surgical documentation
- Live in under 7 days - no migration, no downtime
Trusted by Urology Practices Across 40+ States
Practice Management Software Supported
And 50+ more systems supported
Works with Your Existing Practice Software
No migration. No downtime. Live in days. We connect directly to your urology practice management system without disrupting a single patient appointment.
- Go live in under 7 days from contract signing
- Zero data migration - we work inside your existing system
- 24/7 technical support during and after onboarding
Why Urology Practices Need Specialized Billing Support
Urology is not generic physician billing. A single practice may combine office-based E/M, diagnostic testing, endoscopic procedures like cystoscopy, biopsies, urodynamics, stone procedures, ureteroscopy, lithotripsy, catheter-related services, prostate procedures, and surgical claims.
Each category carries its own modifier logic, payer-specific edits, and documentation expectations. A biller without urology-specific training might not know that a diagnostic cystoscopy generally can't be billed next to a therapeutic one performed the same session, or that the code used for prostate needle biopsy for years was retired on January 1, 2026.
Collection Rate Comparison
Our urology clients recover an average of 15-20% more revenue within the first 90 days of going live.
Where Could Your Urology Practice Be Losing Revenue?
Most urology practices don't lose revenue in one dramatic event — it leaks out through a handful of recurring, identifiable problems. Select the issue closest to what you're seeing.
Eligibility Errors
Possible cause: Coverage or referral requirements not verified before a scheduled procedure.
Billing impact: Same-day cystoscopy or biopsy claims billed against inactive or non-covered plans.
Recommended solution: Confirm eligibility and any referral requirement before every procedure date, not just the initial consult.
Talk to a Billing Specialist →Coding Errors
Possible cause: The wrong CPT selected for approach or imaging guidance — especially under the 2026 prostate biopsy code changes — or a diagnostic cystoscopy billed alongside a therapeutic code that already includes it.
Billing impact: Denials, undercoding, or claims that pay at the wrong level.
Recommended solution: Audit a sample of recent cystoscopy and biopsy claims against current CPT guidance.
Talk to a Billing Specialist →Missing Documentation
Possible cause: Operative notes that don't specify approach, imaging guidance, laterality, or lesion count.
Billing impact: Claims that can't support the code billed, especially under the new lesion-based prostate biopsy reporting rules.
Recommended solution: Check whether operative notes explicitly state imaging modality and approach for every biopsy and endoscopic procedure.
Talk to a Billing Specialist →Authorization Problems
Possible cause: Prior authorization obtained for the wrong procedure code, or expiring before a rescheduled surgery date.
Billing impact: A fully authorized surgery gets denied because the final code billed doesn't match what was authorized.
Recommended solution: Confirm the authorized CPT matches the CPT actually billed — not just the procedure name.
Talk to a Billing Specialist →Claim Rejections & Denials
Possible cause: Formatting errors, mismatched modifiers, NCCI bundling edits (like diagnostic cystoscopy billed alongside a therapeutic cystoscopy), or global-period conflicts.
Billing impact: Valid procedures going unpaid because of a preventable coding conflict.
Recommended solution: Add claim scrubbing before submission and categorize denials by root cause instead of resubmitting claim by claim.
Talk to a Billing Specialist →Aging A/R & Underpayments
Possible cause: Claims that fall out of active follow-up once they pass 60 to 90 days, or payments that don't match the contracted rate.
Billing impact: Revenue your practice already earned but hasn't collected, growing harder to recover the longer it sits.
Recommended solution: Reconcile posted payments against your fee schedule on a regular cadence and prioritize the oldest recoverable balances first.
Talk to a Billing Specialist →How Our Urology Billing Process Works
Every paid claim moves through the same basic path — urology adds extra weight to a few of these steps, particularly documentation review, coding, and modifier/edit review.
| Step | What Happens |
|---|---|
| Patient Registration | Collect accurate demographic, insurance, and referral information at intake. |
| Eligibility Verification | Confirm active coverage, referral requirements, and procedure-specific benefits before the visit. |
| Authorization Review | Secure and track any prior authorization tied to the specific procedure code, not just the procedure name. |
| Documentation Review | Confirm the operative note supports the approach, guidance method, laterality, and findings the code requires. |
| Charge Capture | Record every billable service and supply from the encounter before charges get missed. |
| Coding | Apply current CPT, HCPCS, and ICD-10 codes based on the documented approach, technique, and findings. |
| Modifier / Edit Review | Check modifier use and NCCI pairing before the claim leaves the building. |
| Claim Scrubbing | Run the claim against payer-specific edits and common urology denial patterns. |
| Submission | Submit clean claims electronically to the correct payer within filing deadlines. |
| Payer Adjudication | The payer reviews the claim against coverage, authorization, bundling, and medical necessity rules. |
| Payment Posting | Apply payments and adjustments accurately, flagging mismatches against the contracted rate. |
| Denial Management | Investigate the root cause of any denial, correct it, and resubmit or appeal within payer deadlines. |
| A/R Follow-Up | Track unpaid claims on a defined schedule until resolved. |
| Reporting & Analytics | Review claim, denial, and collection data to catch patterns before they recur. |
Everything Your Urology Practice Needs to Get Paid Right
From cystoscopy coding to the last dollar collected, we handle your entire urology revenue cycle so you can focus on patient care.
Cystourethroscopy & Endoscopic Coding
Diagnostic cystoscopy (52000) carries an NCCI "separate procedure" bundling rule against most therapeutic cystoscopy codes performed the same session. We track every pairing so you're not leaving a genuinely distinct procedure unbilled.
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Prior Authorization & Surgical Scheduling
Surgical and procedural urology services often require authorization tied to the exact CPT code performed, not just the procedure name. We manage every authorization from submission to renewal.
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Prostate Biopsy & Procedure Coding
CPT 55700 was retired January 1, 2026, replaced by a code family split by approach and imaging guidance. Certified coders apply the correct code based on documented technique so claims aren’t denied for a code that no longer exists.
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Charge Entry & Claim Scrubbing
Every charge from cystoscopy to surgical claims is captured and scrubbed against payer-specific edits and NCCI bundling rules before submission — modifier conflicts and bundling errors get caught before the payer sees them.
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Denial Management & Appeals
NCCI bundling denials, authorization mismatches, and documentation-related denials each get investigated for root cause, not resubmitted blind. We build appeals with the documentation the denial actually requires.
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A/R Follow-Up & Collections
Systematic follow-up across Medicare, Medicaid, and commercial payers. Every claim is tracked against its timely filing window so aging balances don’t quietly become unrecoverable ones.
Get StartedUrology Procedure & Specialty Billing
Urology billing isn't one category — a diagnostic cystoscopy, a prostate biopsy, and a stone procedure each carry different coding logic.
Cystoscopy Billing
Diagnostic cystoscopy (52000) carries a "separate procedure" designation, which is an NCCI bundling instruction — it's generally not billed alongside a therapeutic cystoscopy performed in the same session, such as biopsy, fulguration, or stent placement.
Prostate Biopsy Billing
CPT 55700, the single code long used for prostate needle biopsy, was retired effective January 1, 2026 and replaced by a family of codes split by approach (transrectal vs. transperineal) and imaging guidance.
Ureteroscopy & Lithotripsy
Code selection depends on what was actually done during the scope — diagnostic-only, stone removal, or lithotripsy — along with laterality and any applicable modifiers.
Urodynamics
Urodynamic studies require documentation establishing medical necessity and identifying exactly which components were performed and interpreted, since the code set covers several distinct measurements.
TURP / Prostate Procedures
These procedures carry a global surgical period, so claim accuracy depends on documenting the extent of resection, the indication, and correctly separating included postoperative care from any unrelated service.
Stone Management
Stone cases often combine imaging, a procedure, and sometimes a ureteral stent in a coordinated course of care, which means claim coordination across visits and correct sequencing of related codes matters.
2026 Urology Billing Updates to Watch
Sourced from AUA CPT-update coverage and independent coding publications — verify against the current CPT book and payer policy before billing.
Prostate Biopsy Coding Overhaul
CPT 55700 — the single code long used for prostate needle biopsy regardless of approach — was retired effective January 1, 2026. It has been replaced by a family of codes split by approach (transrectal vs. transperineal) and imaging guidance (non-imaging, ultrasound, MRI-fusion, or in-bore). Reporting has also shifted to a lesion-based model: multiple cores from the same lesion are now reported once per lesion, not once per core. Operative notes need to state the imaging modality and approach explicitly — a claim still billed under the retired code for a 2026 date of service is being denied outright.
NCCI Bundling on Cystourethroscopy
CPT 52000 (diagnostic cystourethroscopy) carries a "separate procedure" designation under CPT, which functions as an NCCI bundling instruction: it's a Column Two code against most therapeutic cystoscopy codes performed in the same session — biopsy, fulguration, tumor resection, stent placement, and similar. Modifier 59 or an X-modifier only applies when the cystoscopy is genuinely a distinct service — not simply the introductory step of a therapeutic procedure.
Urology CPT & Billing Reference
| Service / Procedure | Example CPT Family | Key Billing Consideration | Documentation Focus |
|---|---|---|---|
| Diagnostic Cystoscopy | 52000 family | Carries a "separate procedure" designation — an NCCI bundling instruction against most therapeutic cystoscopy codes | Document whether the diagnostic look was genuinely standalone |
| Cystoscopy with Biopsy | 52204 | Includes the diagnostic component — 52000 is not billed alongside it | Lesion location, size, and number of biopsies |
| Prostate Biopsy | 55700 retired 1/1/26; approach + guidance-specific code family | Code depends on transrectal vs. transperineal approach and imaging guidance used | Approach, guidance method, and lesion count stated explicitly |
| Ureteroscopy | 52351–52353 family | Code depends on whether stone removal or lithotripsy was performed during the scope | Laterality and the specific intervention performed |
| Extracorporeal Lithotripsy | 50590 | Generally one unit per treatment session under typical payer policy | Stone location and treatment session |
| Urodynamic Studies | 51728, 51729, 51784, 51797 family | Code depends on exactly which studies were performed and interpreted | Medical necessity and the specific studies performed |
| TURP | 52601 | Carries a global surgical period | Extent of resection and indication |
A starting reference, not a coding manual. Coding always depends on the actual service performed, current CPT guidance, payer policy, and documentation — verify against current sources before billing.
What Is Causing Your Urology Claim Problem?
Select the situation closest to what you’re dealing with right now to see the likely causes.
Claim Rejected
Likely causes: Formatting error, invalid code combination, missing required field.
What to investigate: Clearinghouse rejection report and the specific edit that fired.
How Sirius can help: Claim scrubbing before resubmission.
Claim Denied
Likely causes: Eligibility, authorization, bundling, or medical necessity issue.
What to investigate: Denial reason code (CARC/RARC) on the remittance advice.
How Sirius can help: Root-cause denial categorization and appeal preparation.
Claim Underpaid
Likely causes: Payment posted below the contracted rate, or a modifier reduced payment unexpectedly.
What to investigate: Contracted fee schedule vs. amount actually paid.
How Sirius can help: Payment reconciliation and underpayment appeal.
Claim Stuck in A/R
Likely causes: No follow-up assigned, or payer response never logged.
What to investigate: Claim status directly with the payer.
How Sirius can help: Structured A/R follow-up on a defined schedule.
Authorization Problem
Likely causes: Authorization expired, was obtained for the wrong code, or was never requested.
What to investigate: Authorization number and the code it was actually approved for.
How Sirius can help: Authorization tracking tied to the actual billed code.
Coding Question
Likely causes: Uncertainty about approach-specific or guidance-specific code selection, especially post-2026 changes.
What to investigate: Operative note detail against current CPT guidance.
How Sirius can help: Coding review by staff tracking current urology-specific changes.
Do You Need Specialized Urology Billing?
Answer honestly. A few "yes" answers usually point to specific, fixable gaps rather than a fundamentally broken billing process.
Urology RCM Performance Metrics
Clean Claim Rate
Percentage of claims accepted without preventable errors on first submission. A falling rate signals a breakdown somewhere upstream of submission.
Denial Rate
Percentage of submitted claims denied by the payer. A rising rate on a specific code or payer points to a fixable pattern.
Days in A/R
Average number of days revenue remains outstanding before collection. A climbing number means follow-up is falling behind claim volume.
A/R Aging
Outstanding balances grouped by how long they have been unpaid. A growing 90+ day bucket is the clearest early warning sign.
Net Collection Rate
Percentage of collectible revenue actually collected. A gap between gross and net collection points to write-offs worth reviewing.
First-Pass Resolution Rate
Percentage of claims resolved without rework. A low rate means too much staff time is spent fixing claims after the fact.
Frequently Asked Questions
Request Your Urology Billing Assessment
Your urology practice should not have to chase every claim. With the right combination of eligibility verification, approach-specific coding, and consistent denial follow-up, your revenue cycle can become something your team barely has to think about.
Sirius Solutions Global works with solo urologists, multi-provider groups, and ASC-affiliated practices to manage urology billing from intake through collection — specialty-focused, professional, transparent, structured, and technology-enabled.
(682) 403-6805