CPT 50065 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Urinary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 50065 |
National average reimbursement for CPT 50065 by major payers:
$1,603.66
$1,615.83
$1,655.99
$2,002.64
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 50065 | ||||||
United | 50065 | $604.00 | 1568864452 - CARPUS SURGERY CENTER LLC | 471128977 - (GA) CARPUS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $624.00 | 1831366517 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $1040.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $775.00 | 1881850121 - NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER, LLC | 260211984 - (GA) NORTHEAST GEORGIA UROLOGICAL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $550.00 | 1205945243 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $1056.00 | 1245450295 - MDSINE, LLC, SPINE INSTITUTE OF NEW ENGLAND | 208141112 - (MA) MDSINE LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $4893.00 | 1518344043 - MEMORIAL HERMANN SURGERY CENTER KIRBY, LLC, MEMORIAL HERMANN SURGERY CENTER KIRBY GLEN | 364801162 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $794.00 | 1194437624 - WATAUGA SURGICAL PARTNERS PLLC | 862624496 - (TN) WATAUGA SURGICAL PARTNERS PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $120.00 | 1376657890 - SURGICAL SPECIALTY SUITES, INC | 61784797 - (MD) SURGICAL SPECIALTY SUITES INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $491.00 | 1376580498 - SAME DAY SURGERY CENTERS OF FLORIDA LLC, SAME DAY SURGERY CENTER | 201804147 - (FL) SAME DAY SURGERY CENTERS OF FLORIDA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $436.00 | 1649501073 - SHORE HEALTH SYSTEM, INC., SHORE HEALTH SYSTEM SURGERY CENTER | 520610538 - (MD) SHORE HEALTH SYSTEM INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $589.00 | 1912388026 - SURGICAL CENTER OF PEAK ENDOSCOPY, LLC | 473704021 - (CO) SURGICAL CENTER OF PEAK ENDOSCOPY LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $641.00 | 1215040464 - DEERPATH AMBULATORY SURGICAL CENTER, LLC, DEERPATH ORTHOPEDIC SURGICAL CENTER | 800033465 - (IL) DEERPATH AMBULATORY SURGICAL CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $1056.00 | 1982641064 - PIONEER VALLEY SURGICENTER LLC, PIONEER VALLEY SURGICENTER | 10740204 - (MA) PIONEER VALLEY SURGICENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50065 | $1028.00 | 1891257473 - WESTGATE SURGERY CENTER, LLC, WESTGATE SURGERY CENTER | 352651945 - (AZ) WESTGATE SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 50065 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 50065 code is part of the Surgery services used for Surgical Procedures on the Urinary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 50065 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 50060-CPT | High | Nephrolithotomy; Removal Of Calculus |
| 50065-CPT | High | Nephrolithotomy Secondary |
| 50075-CPT | High | Nephrolithotomy; Removal Of Large Staghorn Calculus Filling Renal Pelvis And Calyces (Including Anatrophic Pyelolithotomy) |
| 50081-CPT | High | Percutaneous Nephrolithotomy Or Pyelolithotomy Lithotripsy Stone Extraction Antegrade Ureteroscopy Antegrade Stent Placement And Nephrostomy Tube Placement When Performed Including Imaging Guidance; Complex (Eg Stone[S] > 2 Cm Branching Stones Stones In Multiple Locations Ureter Stones Complicated Anatomy) (Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 50065. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 50065 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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