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See a sample rate comparisonCPT 51040 Fee Schedule
Last Verified: October 2026
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.
Cystostomy W Drainage
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 51040 |
National average reimbursement for CPT 51040 by major payers:
$380.22
$392.13
$423.61
$484.44
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CPT 51040
5 of 25 sample ratesHigher to lower in this preview
New Gulf Coast Surgery Center, LLC
Gulfport Surgery Clinic, LLC
$7,629.00Published rateHealthcare Enterprises LLC, The Surgery Center
Healthcare Enterprises LLC
$2,145.00Published rateDeschutes Eye Clinic Inc, Eye Surgery Institute
Orion Eye Center, LLC
$1,355.00Published rateMayfair Digestive Health Center, LLC
Mayfair Digestive Health Center LLC
$944.88Published rateCentral Coast Endoscopy Center Inc
$710.00Published rate
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See a sample payer proposalCPT 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 | Urinary Tract Scope Exam, An Exam Of The Upper Portion Of The Urinary Tract. The Procedure Uses A Scope (Endoscope) Inserted Into An Existing Surgical Opening For Draining Urine (Ureterostomy). |
| 51020-CPT | Moderate | Cystotomy Or Cystostomy; W/ Fulgurati &/Or Insrt Of Radioact, Cystotomy Or Cystostomy; With Fulguration And/Or Insertion Of Radioact |
| 51040-CPT | Moderate | Cystostomy W Drainage |
| 51045-CPT | Moderate | Insert Urine Drainage Tube, Surgery To Insert An Artificial Tube Device (Catheter Or Stent) Into The Ureter. The Procedure Is Done By Making A Cut In The Bladder To Access The Ureter. |
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.
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