CPT 50405 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 50405 |
National average reimbursement for CPT 50405 by major payers:
$1,707.96
$1,879.36
$1,999.55
$2,325.22
| 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 50405 | ||||||
United | 50405 | $2799.00 | 1336131143 - PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC, GATEWAY SURGERY CENTER | 860970374 - (AZ) PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1863.00 | 1346621893 - NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | 472128570 - (NJ) NORTHERN NEW JERSEY CENTER FOR ADVANCED ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $7402.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $3210.00 | 1750491205 - ENT SURGERY CENTER OF ATLANTA,LLC | 200075229 - (GA) ENT SURGERY CENTER OF ATLANTALLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1143.00 | 1073601332 - LISA RENFRO SURGERY CENTER LLC | 43612312 - (MD) LISA RENFRO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $2502.00 | 1609872597 - COLISEUM SAME DAY SURGERY CENTER LP | 621805346 - (GA) COLISEUM SAME DAY SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1248.00 | 1366496143 - VIRGINIA SURGERY CENTER, LLC, CVP SURGERY CENTER | 541922041 - (VA) VIRGINIA SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $2200.00 | 1871519314 - NORTHERN LITHO INC | 161511455 - (FL) NORTHERN LITHO, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $3244.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1403.00 | 1700843208 - FAYETTEVILLE AMBULATORY SURGERY CENTER LIMITED PARTNERSHIP, FAYETTEVILLE AMBULATORY SURGERY CENTER | 561754482 - (NC) FAYETTEVILLE AMBULATORY SURGERY | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $6342.00 | 1487399168 - WILLOW PARK ENDOSCOPY CENTER, LLC | 881643733 - (TX) WILLOW PARK ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1763.00 | 1942458062 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1065.00 | 1588638688 - MASONICARE HEALTH CENTER | 60655131 - (CT) MASONICARE HEALTH CENTER | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $2689.00 | 1114584786 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50405 | $1750.00 | 1568079788 - DIALYSIS ACCESS CENTER OF CINCINNATI, INC. | 815023998 - (OH) DIALYSIS ACCESS CENTER OF CINCINNATI INC | OH | 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 50405 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 50405 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 50405 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 |
|---|---|---|
| 50405-CPT | High | Pyeloplasty (Foley Y-Pyeloplasty), Plastic Operation On Renal Pelvis, With Or Without Plastic Operation On Ureter, Nephropexy, Nephrostomy, Pyelostomy, Or Ureteral Splinting; Complicated (Congenital Kidney Abnormality, Secondary Pyeloplasty, Solitary Kidney, Calyco |
| 50430-CPT | Moderate | Injection Procedure For Antegrade Nephrostogram And/Or Ureterogram Complete Diagnostic Procedure Including Imaging Guidance (Eg Ultrasound And Fluoroscopy) And All Associated Radiological Supervision And Interpretation; New Access. |
| 50432-CPT | Moderate | Placement Of Nephrostomy Catheter Percutaneous Including Diagnostic Nephrostogram And/Or Ureterogram When Performed Imaging Guidance (Eg Ultrasound And/Or Fluoroscopy) And All Associated Radiological Supervision And Interpretation. |
| 50540-CPT | High | Symphysiotomy For Horseshoe Kidney With Or Without Pyeloplasty And/Or Other Plastic Procedure Unilateral Or Bilateral (One Operation) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 50405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 50405 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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