Subject: Cystourethroscopies with other Cystourethroscopies
Edit# 304 Effective: 01/15/2004 – 12/31/2014
Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and the edit criteria listed below. Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below.
Description
CODE RULE CODE
52005 Separate Reimbursement 52005
52007
52320
52325
52327
52330
52332
52334
52341
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
52007
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
52346
52347
52351
52352
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
Separate Reimbursement
52342
52343
52344
52345
52346
52347
52351
52352
52353
52354
Separate Reimbursement
Separate Reimbursement
52353
52354
52355 Separate Reimbursement 52355
Rationale
Anthem Central Region does not bundle 52005 with 52005, 52007 with 52007, 52320 with 52320,
52325 with 52325, 52327 with 52327, 52330 with 52330, 52332 with 52332, 52334 with 52334,
52341 with 52341, 52342 with 52342, 52343 with 52343, 52344 with 52344, 52345 with 52345,
Central Region Claim Edit#304 Page 1 of 2
Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc. independent licensee of the Blue Cross and Blue Shield Association
® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CPT
©
is a registered trademark of the American Medical Association
Use of Central Claim Edits: This Edit is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member’s benefits on the date of service. Claim Edits are constantly evolving and we reserve the right to review and update these edits periodically.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Anthem Blue Cross Blue Shield.

52346 with 52346, 52347 with 52347, 52351 with 52351, 52352 with 52352, 52353 with 52353,
52354 with 52354 and 52355 with 52355.
Based on CPT Assistant Article,
"The following procedures are most often performed unilaterally. To identify the additional work required when the procedure is performed bilaterally, modifier-50 should be appended to the procedure code : 52005, 52007 and 52320-52355."
Therefore, if 52005 is submitted with 52005--both will reimburse separately, if 52007 is submitted with 52007--both will reimburse separately, if 52320 is submitted with 52320--both will reimburse separately, if 52325 is submitted with 52325--both will reimburse separately, if 52327 is submitted with 52327--both will reimburse separately, if 52330 is submitted with 52330--both will reimburse separately, if 52332 is submitted with 52332--both will reimburse separately, if 52334 is submitted with 52334--both will reimburse separately, if 52341 is submitted with 52341--both will reimburse separately, if 52342 is submitted with 52342--both will reimburse separately, if 52343 is submitted with 52343--both will reimburse separately, if 52344 is submitted with 52344--both will reimburse separately, if 52345 is submitted with 52345--both will reimburse separately, if 52346 is submitted with 52346--both will reimburse separately, if 52347 is submitted with 52347--both will reimburse separately, if 52351 is submitted with 52351--both will reimburse separately, if 52352 is submitted with 52352--both will reimburse separately, if 52353 is submitted with 52353--both will reimburse separately, if 52354 is submitted with 52354--both will reimburse separately, if 52355 is submitted with 52355--both will reimburse separately.
References
1. American Medical Association. Cystourethroscopy Procedures. CPT Assistant, May 2001;
11(5):-5.
Claim Edit History
01/01/2015
01/15/2004
Archived
Adopted
Central Region Claim Edit#304 Page 2 of 2
Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc. independent licensee of the Blue Cross and Blue Shield Association
® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CPT
©
is a registered trademark of the American Medical Association
Use of Central Claim Edits: This Edit is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member’s benefits on the date of service. Claim Edits are constantly evolving and we reserve the right to review and update these edits periodically.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Anthem Blue Cross Blue Shield.