CPT 50100 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 | • 11 - Office • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • QW - CLIA Waived Tests • 51 - Multiple procedures • 78 - Return to OR - related procedure • 79 - Unrelated procedure - postop period • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| CMS | $1,058.70 Physician Fee Schedule |
National average reimbursement for CPT 50100 by major payers:
$1,459.20
$1,414.17
$1,469.55
$1,747.97
| 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 50100 | ||||||
United | 50100 | $200.00 | 1821098443 - HAZLETON AMBULATORY SURGICAL CENTER LLC | 232971919 - (PA) HAZLETON AMBULATORY SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $600.00 | 1790799047 - WATSONVILLE SURGEONS GROUP LLC, CENTRAL COAST SURGERY CENTER | 770549602 - (CA) WATSONVILLE SURGEON'S GROUP INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $600.00 | 1639290026 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $200.00 | 1649407180 - PAIN MDS INC | 270279190 - (AZ) PAIN MDS INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $368.00 | 1366651242 - MIAMI VALLEY AMBULATORY SURGERY CENTER LTD | 311559473 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $677.00 | 1588765739 - NORTHWEST ENDOSCOPY CENTER, LLC | 911919202 - (WA) NORTHWEST ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $523.00 | 1144516451 - CPMSC GWINNETT, LLC | 274810320 - (GA) CPMSC GWINNETT LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $624.00 | 1558538231 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $623.00 | 1316536352 - UROLOGICAL INSTITUTE OF MARYLAND | 352636464 - (MD) UROLOGICAL INSTITUTE OF MARYLAND | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $1028.00 | 1659748184 - SURGCENTER OF THE POTOMAC, LLC | 472311914 - (MD) SURGCENTER OF THE POTOMAC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $2692.00 | 1477516532 - SPECIALTY SURGICARE OF LAS VEGAS, LP | 260116160 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $507.00 | 1740776517 - TAKLE EYE SURGERY CENTER LLC | 823838597 - (GA) TAKLE EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $740.00 | 1093974602 - EVERGREEN ENDOSCOPY CENTER, LLC | 412211130 - (CT) EVERGREEN ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $950.00 | 1386795540 - THE SURGERY CENTER AT LONE TREE, LLC | 260139211 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50100 | $991.00 | 1467907287 - OPTUM CARE WASHINGTON PLLC, THE EDMONDS SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | 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 50100 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 50100 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 50100 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 50100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 50100 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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