CPT 50961 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| CMS | $377.48 Physician Fee Schedule |
National average reimbursement for CPT 50961 by major payers:
$507.43
$545.49
$548.80
$654.28
| 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 50961 | ||||||
United | 50961 | $1300.00 | 1679656714 - LITTLETON DAY SURGERY CENTER LLC | 232731319 - (CO) LITTLETON DAY SURGERY CENTER | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1245.00 | 1689195786 - SOUTHEAST ATLANTA VASCULAR CARE, LLC | 820825656 - (GA) SOUTHEAST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1476.00 | 1679526297 - WEST BLOOMFIELD SURGERY CENTER, LLC, LAKES SURGERY CENTER | 200449191 - (MI) WEST BLOOMFIELD SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $2388.00 | 1346693124 - VILLAGES ENDOSCOPY CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1150.00 | 1609955517 - KNOXVILLE EYE SURGERY CENTER LLC, TENNESSEE VALLEY EYE CENTER | 621680280 - (TN) KNOXVILLE EYE SURGERY CENTER, LLC; DBA TENNESSEE VALLEY EYE CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1819.00 | 1588619811 - LAWRENCEVILLE SURGERY CENTER, LLC | 582591488 - (GA) LAWRENCEVILLE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1320.00 | 1932613643 - GRAND VIEW SURGERY CENTER AT HARLEYSVILLE, LLC | 822907231 - (PA) GRAND VIEW SURGERY CENTER AT HAR | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $500.00 | 1538231956 - COASTAL MEDICAL CENTER LLC | 650956639 - (FL) COASTAL MEDICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1175.00 | 1487625802 - PERIMETER CENTER FOR OUTPATIENT SURGERY LP | 581978405 - (GA) PERIMETER CENTER FOR OUTPATIENT SURGERY LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1300.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $995.00 | 1578515995 - RAND SURGICAL PAVILLION CORP | 650156637 - (FL) RAND SURGICAL PAVILLION CORP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1070.00 | 1780292110 - BUCKEYE SOUTH LLC, BUCKEYE SURGERY CENTER | 832419523 - (AZ) BUCKEYE SOUTH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $645.00 | 1548655053 - MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER, LLC | 463162562 - (MS) MISSISSIPPI UROLOGY OUTPATIENT SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $1500.00 | 1629313739 - COLTON CA MULTI ASC LP, PREMIER OUTPATIENT SURGERY CENTER | 461462978 - (CA) COLTON CA MULTI ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 50961 | $509.00 | 1023055001 - ZION AMBULATORY CENTER LLC | 203243084 - (MD) ZION AMBULATORY CENTER LLC | MD | 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 50961 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 50961 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 50961 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 |
|---|---|---|
| 50951-CPT | Moderate | Ureteral Endoscopy Through Established Ureterostomy, With Or Without Irrigation, Instillation, Or Uretero-Pyelography, Exclusive Of Radiologic Service; |
| 50953-CPT | Moderate | Ureteral Endoscopy Through Established Ureterostomy, With Or Without Irrigation, Instillation, Or Ureteropyelography, Exclusive Of Radiologic Service; With Ureteral Catheterization, With Or Without Dilation Of Ureter |
| 50955-CPT | Moderate | Ureteral Endoscopy Through Established Ureterostomy, With Or Without Irrigation, Instillation, Or Uretero-Pyelography, Exclusive Of Radiologic Service; With Biopsy |
| 50961-CPT | Moderate | Ureteral Endoscopy Through Established Ureterostomy, With Or Without Irrigation, Instillation, Or Ureteropyelography, Exclusive Of Radiologic Service; With Removal Of Foreign Body Or Calculus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 50961. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 50961 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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