CPT 51597 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 62 - Co-Surgeons • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 51597 |
National average reimbursement for CPT 51597 by major payers:
$2,799.30
$3,083.14
$3,261.60
$3,820.40
| 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 51597 | ||||||
United | 51597 | $676.00 | 1922412790 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC, SENTARA KITTY HAWK AMBULATORY SURGERY CENTER | 463846081 - SENTARA ALBEMARLE REGIONAL MEDICAL CENTER, LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $1049.00 | 1104082692 - OLD TESSON SURGERY CENTER, L.P., OLD TESSON SURGERY CENTER | 262876334 - (MO) OLD TESSON SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $11123.00 | 1225064876 - ROCK HILL SURGERY CENTER, LLC, CAROLINA SURGICAL CENTER | 752562111 - (SC) ROCK HILL SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $1064.00 | 1114302353 - POINT OF ROCKS SURGERY CENTER, LLC | 464992977 - (MD) POINT OF ROCKS SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $3563.00 | 1467920389 - KU MEDWEST AMBULATORY SURGERY CENTER, LLC | 20664568 - (KS) KU MEDWEST AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $565.00 | 1649791641 - NORTHEAST ATLANTA VASCULAR CARE, LLC | 453857751 - (GA) NORTHEAST ATLANTA VASCULAR CARE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $1064.00 | 1295344026 - WEST CHESTER SURGICAL SUITES, LLC | 845072006 - (OH) WEST CHESTER SURGICAL SUITES LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $250.00 | 1427003904 - PHILADELPHIA WOMEN'S CENTER, INC. | 232476628 - (PA) PHILADELPHIA WOMENS CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $923.00 | 1205845740 - THE UROLOGY CENTER LLC | 311579733 - (OH) THE UROLOGY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $3695.00 | 1336148360 - BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER, LLC, BOULDER SURGERY CENTER | 201391702 - (CO) BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $624.00 | 1306013925 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $300.00 | 1194708792 - OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE PC, SURGERY CENTER OF OPHTHALMOLOGY CONSULTANTS | 351581864 - (IN) OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE, P.C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $843.00 | 1770114290 - NORTH SUBURBAN PAIN AND SPINE CENTER LLC | 824454412 - (IL) NORTH SUBURBAN PAIN & SPINE CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $3581.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51597 | $625.00 | 1770149304 - BLACK RIVER AMBULATORY SURGERY CENTER, LLC | 834657999 - (MO) BLACK RIVER AMBULATORY SURGERY CENTER LLC | MO | 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 51597 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51597 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 51597 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 |
|---|---|---|
| 51570-CPT | High | Cystectomy Total |
| 51580-CPT | High | Cystectomy,Complete,Ureterosigmoid/-Cuta |
| 51585-CPT | High | Cystectomy, Complete, With Ureterosigmoidostomy Or Ureterocutaneous Transplantations; With Bilateral Pelvic Lymphadenectomy, Including External Iliac, Hypogastric, And Obturator Nodes |
| 51597-CPT | High | Pelvic Exenteration, Complete, For Vesical, Prostatic Or Urethral Malignancy, With Removal Of Bladder And Ureteral Transplantations, With Or Without Hysterectomy And/Or Abdominoperineal Resection Of Rectum And Colon And Colostomy, Or Any Combination Thereof |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51597. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51597 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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