NCDActive
Treatment of Kidney Stones
NCD106
Effective: January 16, 1988
Updated: December 31, 2025
Policy Summary
Medicare covers extracorporeal shock wave lithotripsy (ESWL) for upper urinary tract kidney stones, percutaneous nephrolithotomy/lithotripsy (ultrasound, electrohydraulic, or mechanical) for kidney stones, and transurethral ureteroscopic lithotripsy (mechanical, electrohydraulic, ultrasound, or laser) for stones of the kidney or ureter. Coverage is effective for ESWL and percutaneous techniques on or after 1985-03-15 and for ureteroscopic lithotripsy on or after 1988-01-16; imaging guidance for ESWL is described in the policy.
Coverage Criteria Preview
Key requirements from the full policy
"Extracorporeal shock wave lithotripsy (ESWL) is covered for treatment of upper urinary tract kidney stones."
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