CPT 51726 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • TC - Technical component |
| Complexity Level | Moderate |
| CMS | $188.26 Physician Fee Schedule |
National average reimbursement for CPT 51726 by major payers:
$346.01
$393.83
$435.34
$505.57
| 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 51726 | ||||||
United | 51726 | $907.00 | 1457465403 - VENTURE AMBULATORY SURGERY CENTER | 743257508 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $500.00 | 1073081501 - MILFORD-FRANKLIN EYE CENTER, LLC | 43287594 - (MA) MILFORD-FRANKLIN EYE CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $574.00 | 1366684326 - PRINCE FREDERICK SURGERY CENTER LLC | 264387021 - (MD) PRINCE FREDERICK SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $290.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $531.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $70.00 | 1225199482 - ST MARKS SURGICAL CENTER LLC | 364577700 - (FL) ST MARKS SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $737.00 | 1275886319 - SURGERY CENTER OF BAY AREA HOUSTON, LLC | 320383244 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $252.00 | 1891186987 - FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER,LLC | 464426708 - (CO) FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTERLLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $312.00 | 1619933264 - SALEM SURGERY CENTER, LLC | 742462470 - (OR) SALEM SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $907.00 | 1457465403 - VENTURE AMBULATORY SURGERY CENTER | 743257508 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $207.00 | 1568867075 - POTOMAC VIEW SURGERY CENTER, LLC | 471352116 - (MD) POTOMAC VIEW SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $175.00 | 1043660442 - GEORGIA INTERVENTIONAL PAIN | 812790376 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $566.00 | 1265466288 - TAMARAC SURGERY CENTER LLC, THE SURGERY CENTER OF FT LAUDERDALE | 650963549 - (FL) TAMARAC SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $830.00 | 1619333010 - ORANGE ASC, LTD, ORTHOPEDIC ONE SURGERY CENTER AT EASTON | 464700223 - (OH) ORANGE ASC LTD DBA ORTHOPEDIC ONE SURGERY CENTER AT EASTON | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51726 | $91.00 | 1396733945 - EYE LASER & SURGERY CENTER OF COLUMBUS, LLC | 640942234 - (MS) EYE LASER SURGERY CENTER OF COLUMBUS LLC | MS | 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 51726 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51726 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 51726 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 |
|---|---|---|
| 51610-CPT | Low | Inject.Proced.For Retrograde Urethrocyst |
| 51725-CPT | Moderate | Cmg Simple |
| 51726-CPT | Moderate | Complex Cystometrogram-Eg,Calibrated Ele |
| 51727-CPT | Moderate | Complex Cystometrogram (Ie, Calibrated Electronic Equipment); With Urethral Pressure Profile Studies (Ie, Urethral Closure Pressure Profile), Any Technique |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51726. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51726 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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