Reimbursement

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Meet the Reimbursement Team

For Reimbursement support, please call 855-574-1140 or email coding@calyxoinc.com

Susan Crews, CPC, ACS-UR

Senior Manager, Reimbursement and Market Access – Northeast

Full Bio

Susan Crews has over 30 years of experience specializing in urology coding, billing, and training. She spent 12 years at the American Urological Association leading national coding seminars, managing the coding hotline, and working with insurers to secure proper coverage. Prior to the AUA, she was billing supervisor for a 10-physician urology practice in Maryland. Susan is certified as a CPC, ACS-UR, and ICD-10-CM Trainer, and is widely recognized as a respected expert in urology reimbursement and market access.

Edna Maldonado, CPC, ACS-UR

Manager, Reimbursement and Market Access – Southeast

Full Bio

With over 30 years of experience in urology, Edna Maldonado has served as a Coding Education Trainer for the American Urological Association, conducting national coding seminars, webinars, and customized training sessions for urology practices in the US. She served as Co-Course Director for the AUA’s annual Coding Seminars and is an active member of the AUA Leadership & Business Education Committee. Prior to her work at AUA, she was Office Manager at Town & Country Urology for 20 years. Edna has also held leadership roles in her local AAPC Chapter as Treasurer and Vice President.

Danielle Jones

Manager, Reimbursement and Market Access – Central

Full Bio

Danielle brings over 20 years of revenue cycle management expertise with extensive experience in medical billing, coding, payer reimbursement strategies, and process optimization across a range of specialties, including urology, behavioral health, and skilled nursing. Danielle is recognized for driving measurable results, navigating complex claims and denials, and implementing scalable processes that minimize financial risk.

Khang Bui

Manager, Reimbursement and Market Access – West

Full Bio

Khang Bui has nearly a decade of experience supporting healthcare providers with reimbursement needs and helping patients gain access to innovative medical technologies. His background spans both the health insurance sector and the medical device industry, where he has guided providers and facilities through challenges with authorizations, claims, and appeals. Khang holds a BS in Clinical Psychology with a minor in General Biology from the University of California, San Diego.

Billing Guide

SURE Procedure with CVAC System Has Dedicated Reimbursement

For Reimbursement support, please call 855-574-1140 or email coding@calyxoinc.com

CVAC System Coding Guide: Physician and Facility

Common ICD-10-CM1 Diagnosis Code

ICD-10-CM Diagnosis Code Description
N20.0 Calculus of kidney

Professional Fee Coding

RVUs/rates listed are based on Calendar Year 2025 Medicare Physician Fee Schedule2

CPT3 Description Work RVUs Total RVUs 2025 Medicare National Average Payment
52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) 7.50 11.60 $375
OR
52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) 8.00 12.32 $399

If the physician believes the work of a particular case is above a standard ureteroscopy, possibly warranting additional payment, refer to individual payer guidelines regarding the correct use of Modifier 22 or the use of the urology unlisted code (CPT 53899). Whether either option is appropriate depends on the specifics of the individual case, physician and coder discretion, and/or payer guidelines. Note that clinical documentation in the operative note must substantiate the use of Modifier 22 or the unlisted code. Consult your Calyxo Reimbursement Manager to discuss billing and coding for complex cases.

Facility Fee CVAC System Coding Guide

Hospital Outpatient and Ambulatory Surgery Center—2025 Medicare National Average Payment4

HCPCS5 Description Hospital Outpatient ASC
C9761* Cystourethroscopy, with ureteroscopy and/or pyeloscopy, with lithotripsy, and ureteral catheterization for steerable vacuum aspiration of the kidney, collecting system, ureter, bladder, and urethra if applicable (must use a steerable ureteral catheter) $9,247
(APC 5376)		 $4,780
AND*
C1747** Endoscope, single-use (i.e., disposable), urinary tract, imaging/illumination device (insertable) Hospital charges reduced by hospital-specific CCR minus device offset percentage** Invoice amount**

* Physician Operative Report must indicate that a CVAC System with a steerable ureteral catheter was utilized to perform vacuum aspiration and facilitate removal of stone fragments and debris from the kidney.

** C1747 is a temporary Transitional Passthrough Payment (TPT) device code, representing a disposable ureteroscope, that the hospital may bill along with the C9761 procedure through the end of CY 2025. Please contact your Calyxo Reimbursement Manager for a tutorial and resources on appropriate billing of the TPT through 2025.

Frequently Used Modifiers

Modifier Description Notes
50 Bilateral Procedure Indicates procedure was performed on both sides of the body. Procedure will usually be paid at 150% of the single procedure code by Medicare.
52 Reduced Procedure Indicates only a portion of the procedure was completed. Procedure will usually be paid at a 50% reduction of unmodified code by Medicare.
58 Staged Procedure Indicates that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (i.e., staged); more extensive than the original procedure; or for the therapy following a surgical procedure. Procedure will usually be paid at 100%.

Prior Authorization Process for CVAC System

Prior authorization is recommended for commercial insurance, Medicare Advantage, and Medicaid. It is not required for traditional fee-for-service Medicare.

Submit a prior authorization request for CPT 52353 or 52356 for Physician and HCPCS Code C9761 for Facility. When prior authorizing C9761, make clear to the insurance company that this code is being authorized on behalf of the facility and not the physician. C9761 is a facility-only code. Failure to stipulate that the C9761 is a prior authorization for the facility and not the physician may result in a preventable denial.

References:

  1. International Classification of Diseases, 10th Revision, Clinical Modification.
  2. Centers for Medicare & Medicaid Services Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule. Retrieved from Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule | CMS.
  3. American Medical Association. (2024) Current Procedural Terminology (CPT) 2024. Chicago, IL: American Medical Association.
  4. Centers for Medicare & Medicaid Services Calendar Year (CY) 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC). Retrieved from CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC) | CMS.
  5. Centers for Medicare & Medicaid Services (2025). Healthcare Common Procedure Coding System (HCPCS) Level II. Retrieved from List of CPT/HCPCS Codes | CMS.

Disclaimer: The information contained in this guide is for informational purposes only and represents no statement, promise, or guarantee by Calyxo, Inc., concerning levels of reimbursement or payment. It is always the responsibility of the provider to determine if the services provided are accurately described by any specific code(s) and to report services consistent with specific payer requirements. Providers should select the most appropriate HCPCS / CPT® code(s) with the highest level of detail to describe the service(s) rendered to the patient as well as the most appropriate ICD-10-CM diagnosis code(s) to describe the patient’s condition. Any questions should be directed to the pertinent payer regarding reimbursement policies. This information is subject to change at any time. In all cases, services billed must be medically necessary, performed as reported and appropriately documented.

PRS Urology Coding and Reimbursement Hub

The PRS Urology Coding and Reimbursement Hub was designed to simplify urology coding and reimbursement. The CVAC System has a dedicated page where facilities and provider offices can learn and confirm correct coding for the SURE procedure using the CVAC Aspiration System. Simply click here to learn more about coding.

PRS is an independent consultant working with Calyxo.

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