CVAC System
Physician Coding
When using the CVAC System, report the appropriate procedure code for the service(s) performed. Please refer to the Kidney Stone Coding Hub Page for detailed billing guidance related to kidney stones.
Example: If you performed lithotripsy on a kidney stone in the pelvis of the kidney and inserted a stent, it would be coded as follows:
52356
Append Modifier -22 to the Procedure Code
Modifier -22 is used when a procedure requires significantly more effort than is typically necessary. When performing a procedure with the CVAC System from Calyxo, you may encounter scenarios where additional time, complexity, or intensity justifies appending Modifier -22.
Alternative Option
Some payers suggest reporting CPT code 53899 (crosswalked to 52001) for the additional work of placing ureter access with suction capabilities in addition to CPT 52356 or 52353. Please check with your payer.
(Do not use unlisted code if 52352 is reported for removal of non-contiguous stones.)
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Reporting use of ureter access sheath with suction component
https://www.urologytimes.com/view/reporting-use-of-ureter-access-sheath-with-suction-component -
Can you report CPT 52352 when removing fragments of a stone lasered in the ureter?
https://www.urologytimes.com/view/can-you-report-cpt-52352-when-removing-fragments-of-a-stone-lasered-in-the-ureter- -
Billing for nephroscopy with ureteroscopy and laser lithotripsy
https://www.urologytimes.com/view/billing-for-nephroscopy-with-ureteroscopy-and-laser-lithotripsy -
Urology Coding and Reimbursement Podcast Episode #232: Work RVUs and Modifier 22, Unlisted Codes, Category III Codes – Navigating Payer Reporting and Administrator Discussions
https://www.prsnetwork.com/232 -
Understanding RVUs, Modifier 22, and Unlisted Codes: A Guide for Urologists
https://www.prsnetwork.com/urologistsguide
Facility Coding
ASC (Ambulatory Surgery Center)
For 2025, the CVAC system has a Transitional Pass Through (TPT) designation.
Therefore, the calculation includes a device offset amount in addition to a TPT payment.
Please see below for an example using Medicare National Values for Q2 2025.
HOPD (Hospital Outpatient)
For 2025, the CVAC system has a Transitional Pass Through (TPT) designation.
Therefore, the calculation includes a device offset amount in addition to a TPT payment.
Please see below for an example using Medicare National Values for Q2 2024.
Please note that the above example uses a Hospital Markup of 3 and a Hospital Cost-to-Charge ratio of 0.3. These values may vary based on your specific situation.
Enter facility accordion dropdown content here.
EOBs
EOB INTRO (EDIT ME): Add EOB notes here. If you want a Google Sheet embed, paste your iframe below.
