CPT 51520 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 • AS - PA/NP/CNS assistant at surgery • 82 - Assistant surgeon - no qualified resident • LT - Left side of body • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 51520 |
National average reimbursement for CPT 51520 by major payers:
$773.89
$799.07
$820.16
$997.92
| 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 51520 | ||||||
United | 51520 | $1309.00 | 1548710775 - LINCOLN DIGESTIVE HEALTH CENTER LLC | 371833798 - (NE) LINCOLN DIGESTIVE HEALTH CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $968.00 | 1477848992 - VASCARE | 275431592 - (WI) VASCARE MAYFAIR LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $2353.00 | 1003058744 - YORK COUNTY ENDOSCOPY CENTER LLC | 463366385 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $513.00 | 1083654636 - PLASTIC SURGERY SPECIALISTS, PC, NORTH ARUNDEL PLASTIC SURGERY SPECIALISTS | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $1172.00 | 1912641788 - PACIFIC NORTHWEST SURGERY CENTER LLC | 842331435 - (OR) PACIFIC NORTHWEST SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $2500.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $2307.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $2928.00 | 1588746333 - TALLAHASSEE ORTHPAEDIC SURGERY PARTNERS LTD | 752535417 - (FL) TALLAHASSEE ORTHPAEDIC SURGERY PARTNERS LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $713.00 | 1376513440 - FLORIDA EYE CLINIC AMBULATORY SURGERY CENTER, INC. | 592303141 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $4960.00 | 1649482449 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $1146.00 | 1073845087 - EYE SURGERY CENTERS OF ARIZONA, LLC, EYE SURGERY AT THE BILTMORE, LLC | 271798256 - (AZ) EYE SURGERY CENTERS OF ARIZONA 401(K) PROFIT SHARING PLAN & TRUST | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $2827.00 | 1235146325 - WEBSTER AMBULATORY SURGERY CENTER LP, WEBSTER SURGERY CENTER | 205953387 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $5124.00 | 1700057254 - NORTH STATE SURGERY CENTERS, LP, MERCY SURGERY CENTER | 300197423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $3427.00 | 1497749667 - CALIFORNIA SPECIALTY SURGERY CENTER, LLC, CALIFORNIA SPECIALTY SURGERY CENTER, LLC | 330939003 - (CA) CALIFORNIA SPECIALTY SURGERY CENTER, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51520 | $1050.00 | 1033560420 - ABINGDON SURGICAL CENTER PC | 813054896 - (MD) ABINGDON SURGICAL CENTER PC | 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 51520 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51520 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 51520 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51520 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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