CPT 51040 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 51040 |
National average reimbursement for CPT 51040 by major payers:
$380.22
$392.13
$423.61
$494.45
| 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 51040 | ||||||
United | 51040 | $2965.00 | 1326309394 - ADVANCED SURGERY CENTER OF ORLANDO LLC | 453785008 - (FL) ADVANCED SURGERY CENTER OF ORLANDO LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $2500.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 223717100 - PREMIER SURGICAL CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $834.00 | 1336208081 - ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH | 593740436 - (FL) ATLANTIC SURGERY CENTER OF JACKSONVILLE BEACH | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1662.00 | 1750862389 - PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC | 831536863 - (GA) PEDIATRIC AND ADULT SURGERY CENTER OF ATLANTA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1420.00 | 1013417351 - BURNSIDE SURGERY CENTER LLC | 821290460 - (OR) BURNSIDE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $3373.00 | 1003842626 - AMBULATORY CENTER FOR ENDOSCOPY, LLC | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $936.00 | 1629404918 - CENTRAL ARKANSAS SURGERY CENTER, LLC | 462585307 - (AR) CENTRAL ARKANSAS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1355.00 | 1063635506 - DESCHUTES EYE CLINIC INC, EYE SURGERY INSTITUTE | 931148247 - (OR) ORION EYE CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1900.00 | 1295848752 - ESSEX SURGICAL ARTS SURGERY CENTER, LLC, MOBILE VASCULAR PHYSICIANS | 202242123 - (NJ) ESSEX SURGICAL ARTS SURGERY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $883.00 | 1740246792 - PREMIER SURGERY CENTER OF LOUISVILLE LP, PREMIER SURGERY CENTER OF LOUISVILLE | 721378216 - (KY) PREMIER SURGERY CENTER OF LOUISVILLE LP | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1391.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $710.00 | 1760423180 - CENTRAL COAST ENDOSCOPY CENTER INC | 770456846 - (CA) CENTRAL COAST ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1090.00 | 1700437423 - JOHNS HOPKINS SURGERY CENTERS SERIES, LUTHERVILLE SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1259.00 | 1285692004 - TEC NORTH, LLC, THE ENDOSCOPY CENTER NORTH | 201871076 - (TN) TEC NORTH LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $850.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 814348805 | GA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 51040 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51040 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 51040 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; |
| 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 |
| 51020-CPT | Moderate | Cystostomy W Fulgurat/Insert Rad |
| 51040-CPT | Moderate | Cystostomy W Drainage |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51040 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 51040) and we'll show you how you compare in 15 minutes or less.