CPT 51797 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 |
| Medicare Fee Schedule | View Medicare rates for 51797 |
National average reimbursement for CPT 51797 by major payers:
$217.91
$216.96
$247.78
$299.65
| 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 51797 | ||||||
United | 51797 | $240.00 | 1154370146 - MICHIGAN SURGICAL CENTER,LLC | 383210989 - (MI) MICHIGAN SURGICAL CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $112.02 | 1790205862 - SHEA SOUDERS | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
United | 51797 | $446.00 | 1366521643 - MEDICAL AMBULATORY SURGICAL SUITES LLP, KIRBY SURGICAL CENTER | 680550412 - (TX) KIRBY SURGICAL CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $261.00 | 1063531911 - NJ VEIN & COSMETIC SURGERY CENTER, PA | 223328362 - (NJ) NJ VEIN COSMETIC SURGERY CENTER PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $82.00 | 1346215316 - CHESAPEAKE EYE SURGERY CENTER, LLC | 522310068 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $770.00 | 1053381236 - METHODIST SURGERY CENTER GERMANTOWN LP | 621659904 - (TN) METHODIST SURGERY CENTER GERMANTOWN LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $127.00 | 1588329098 - GHS SERVICES, LLC, GASTRO SOUTH ENDOSCOPY CENTER | 854238832 - (GA) GHS SERVICES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $478.00 | 1093705774 - SURGICENTER OF MANSFIELD, LTD. | 311515255 - (OH) SURGICENTER OF MANSFIELD, LTD. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $1301.00 | 1578530226 - PHYSICIANS SURGICAL CENTER OF FT. WORTH LLP, BAYLOR SCOTT & WHITE SURGICARE FORT WORTH | 208303422 - (TX) PHYSICIANS SURGICAL CENTER OF FT WORTH LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $217.00 | 1679696157 - ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES, LLC, SLOCUM AMBULATORY SURGERY CENTER | 770590285 - (OR) ORTHOPEDIC HEALTHCARE ANCILLARY SERVICES LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $368.00 | 1639669476 - UCHEALTH AMBULATORY SURGERY CENTERS, LONGS PEAK SURGERY CENTER, LLC | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $1814.00 | 1043275183 - FOREST AMBULATORY SURGICAL ASSOCIATES LLC, FOREST SURGERY CENTER | 942934248 - (CA) FOREST AMBULATORY SURGICAL ASSOCIATES, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $193.00 | 1649682014 - ENTI SURGERY CENTER LLC | 462334845 - (GA) ENTI SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $790.00 | 1366137440 - SURGERY CENTER OF GEORGETOWN, LLC, GEORGETOWN SURGERY CENTER | 880604963 - (TX) SURGERY CENTER OF GEORGETOWN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51797 | $33.47 | 1982137428 - JENNIFER LAMPERT | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
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 51797 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51797 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 51797 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 51797. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51797 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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