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See a sample rate comparisonCPT 51065 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.
Treatment Of Urinary Stones, Procedure To Remove Or Destroy A Stone In The Ureter (Passage From Kidney To Bladder). The Procedure Is Done By Making An Incision (Cut) In The Bladder And Removing The Stone With A Basket-Type Instrument.
| 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 59 - Distinct Procedural Service 62 - Co-Surgeons AS - PA/NP/CNS assistant at surgery 22 - Increased Procedural Services 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 51065 |
| Medicaid Fee Schedule | View Medicaid rates for 51065 |
National average reimbursement for CPT 51065 by major payers:
$778.86
$776.73
$792.22
$949.40
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CPT 51065
5 of 25 sample ratesHigher to lower in this preview
Roc Surgery LLC, Riley Outpatient Surgery Center
Roc Surgery LLC
$8,705.00Published rateBristol Ambulatory Surgery Center, LLC
$2,353.00Published rateMid Cities Asc, Lp
$1,550.00Published rateWilmington Surgery Center, Lp, Wilmington Surgcare
Wilmington Surgery Center Lp
$1,015.00Published rateBrighton Surgery Center, LLC
$580.00Published rate
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See a sample payer proposalCPT 51065 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51065 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 51065 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 |
|---|---|---|
| 51050-CPT | Moderate | Cystolithotomy Cystotomy W/Remval Of Calculus W/O Vesical Ne, Cystolithotomy Cystotomy With Removal Of Calculus Without Vesical Ne |
| 51060-CPT | Moderate | Pass Kidney Stone Out Bladder, Access Kidney Stone In The Ureter (Tube From Kidney Connected To Bladder) Through Surgical Cut In The Bladder. |
| 51065-CPT | Moderate | Treatment Of Urinary Stones, Procedure To Remove Or Destroy A Stone In The Ureter (Passage From Kidney To Bladder). The Procedure Is Done By Making An Incision (Cut) In The Bladder And Removing The Stone With A Basket-Type Instrument. |
| 51530-CPT | Moderate | Cystotomy;For Excis-Bladder Tumor |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51065. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51065 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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