CPT 51792 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 • 51 - Multiple procedures • 26 - Professional component |
| Complexity Level | Moderate |
| CMS | $54.02 Physician Fee Schedule |
National average reimbursement for CPT 51792 by major payers:
$288.59
$320.61
$343.66
$434.88
| 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 51792 | ||||||
United | 51792 | $107.00 | 1013997915 - KNOXVILLE OPHTHALMOLOGY ASC, LLC, EYE SURGERY CENTER OF EAST TENNESSEE | 621595885 - (TN) KNOXVILLE OPHTHALMOLOGY ASC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $100.00 | 1679757959 - THOMAS JOHNSON SURGERY CENTER, LLC | 261579919 - (MD) THOMAS JOHNSON SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $90.00 | 1518922541 - VISION SURGICAL CENTER AT SPRINGHILL PSC | 352100428 - (IN) VISION SURGICAL CENTER AT SPRINGHILL PSC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $149.00 | 1750343083 - LEXINGTON SURGERY CENTER LTD | 611028180 - (KY) LEXINGTON SURGERY CENTER LTD | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $2287.00 | 1477140796 - PORTSMOUTH SURGICENTER, LLC | 833659705 - (NH) PORTSMOUTH SURGICENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $325.00 | 1710924899 - DMG SURGICAL CENTER LLC, SURGICAL CENTER OF DUPAGE MEDICAL GROUP | 371474161 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $90.00 | 1669075495 - SAINT JOSEPH HEALTH ASC LLC | 611235517 - (KY) THE PAIN TREATMENT CENTER, INC. DBA STONE ROAD S | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $688.00 | 1114202892 - ALVARADO EYE SURGERY CENTER LLC | 453181784 - (CA) ALVARADO EYE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $150.00 | 1639682503 - SOUTH PLAINS SURGERY CENTER LLC | 822142398 - (TX) SOUTH PLAINS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $250.00 | 1821036534 - PARKWAY SURGERY CENTER, LLC | 204127100 - (MD) PARKWAY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $125.00 | 1548216914 - UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC | 450470832 - (TN) UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $401.00 | 1881612042 - THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA, LLC | 200147862 - (GA) THE HAND AND UPPER EXTREMITY SURGERY CENTER OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $359.00 | 1376595421 - OTAY LAKES SURGERY CENTER, LLC | 200794766 - (CA) OTAY LAKES SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $500.00 | 1831368356 - VERMONT EYE SURGERY & LASER CENTER | 204872230 - (VT) VERMONT EYE SURGERY & LASER CENTER, LLC 401(K) PLAN | VT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51792 | $574.00 | 1558753095 - PACIFIC ENDOSCOPY CENTER LLC | 203905706 - (HI) PACIFIC ENDOSCOPY CENTER, LLC | HI | 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 51792 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51792 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 51792 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 |
|---|---|---|
| 51784-CPT | Low | Electmygrph Study (Emg) Of Anal/Urthr Sphnctr, Oth Thn Needl, Any Tech |
| 51785-CPT | Moderate | Emg Anal/Urethral Sphincter |
| 51792-CPT | Moderate | Stimulus Evoked Response |
| 51797-CPT | Moderate | Voiding Pressure Studies (Vp); Intra-Abdominal Voiding Pressure (Ap) (Rectal Gastric Intraperi- Toneal)(List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51792. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51792 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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