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 |
| CMS | $286.59 Physician Fee Schedule |
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 | $1371.00 | 1205076593 - HEALTHCARE PARTNERS ASC-HB, LLC, TALBERT SURGICAL ASSOCIATES, LLC | 264247365 - (CA) HEALTHCARE PARTNERS ASCHB LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $850.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1400.00 | 1326402884 - ORTHOPAEDIC INSTITUTE FOR CHILDREN AMBULATORY SURGERY CENTER, LLC | 812159060 - (CA) ORTHOPAEDIC INSTITUTE FOR CHILDREN AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $5379.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1300.00 | 1275132094 - COASTAL CARDIOVASCULAR CENTER, LLC, COASTAL CARDIOVASCULAR CENTER | 845144651 - (TX) COASTAL CARDIOVASCULAR CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $2941.00 | 1295790327 - ENDOSCOPY OF PLANO, LP, GASTROINTESTINAL ENDOSCOPY CENTER OF PLANO | 201477775 - (TX) ENDOSCOPY OF PLANO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1167.00 | 1871574145 - SURGERY CENTER AT REGENCY PARK, LLC | 311570817 - (OH) SURGERY CENTER AT REGENCY PARK, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $3373.00 | 1003842626 - AMBULATORY CENTER FOR ENDOSCOPY, LLC | 200064962 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1200.00 | 1487742680 - NOVAMED SURGERY CENTER OF CLEVELAND LLC, THE SURGERY CENTER OF CLEVELAND | 205493062 - (TN) NOVAMED SURGERY CENTER OF CLEVELAND LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $2795.00 | 1043297872 - CENTRAL JERSEY AMBULATORY SURGICAL CENTER, LLC | 223669777 - (NJ) CENTRAL JERSEY AMBULATORY SURGICAL CENTER LLC | NJ | 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 | $1420.00 | 1013417351 - BURNSIDE SURGERY CENTER LLC | 821290460 - (OR) BURNSIDE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1599.00 | 1699711382 - TOWSON SURGICAL CENTER LLC, TOWSON SURGICAL CENTER | 521945958 - (MD) TOWSON SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1633.00 | 1073505038 - PALMETTO SURGERY CENTER LLC | 582333248 - (SC) PALMETTO SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51040 | $1023.00 | 1134427297 - SURGERY CENTER OF ZACHARY, LLC | 811928790 - (LA) SURGERY CENTER OF ZACHARY, LLC | LA | 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 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.
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