CPT 51798 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 • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| CMS | $11.32 Physician Fee Schedule |
National average reimbursement for CPT 51798 by major payers:
$18.24
$19.32
$22.16
$23.22
| 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 51798 | ||||||
United | 51798 | $705.00 | 1154199859 - WATSON CLINIC ASC, LLC | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $125.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 541052755 - (VA) VIRGINIA EAR, NOSE & THROAT ASSOCIATES, P.C. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $646.80 | 1417944778 - MERRIMACK VALLEY ENDOSCOPY CENTER | 43578297 - (MA) MERRIMACK VALLEY ENDOSCOPY CENTER | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $1511.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $688.00 | 1558401299 - SAN GABRIEL VALLEY SURGICAL CENTER LP | 752965449 - (CA) SAN GABRIEL VALLEY SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $650.00 | 1154590271 - UNITY SURGICAL CENTER, LLC, UNITY SURGICAL CENTER | 352099067 - (IN) UNITY SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $119.00 | 1225228547 - GULF COAST SURGICAL CENTER LLC | 203321032 - (LA) GULF COAST SURGICAL CENTER, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $52.00 | 1841589116 - RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC | 273013392 - (TN) RENAISSANCE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $100.00 | 1184675704 - DOCTORS SURGERY CENTER LLC | 593518740 - (FL) DOCTORS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $688.00 | 1588867030 - PACIFIC ENDO-SURGICAL CENTER LP | 562387275 - (CA) PACIFIC ENDOSURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $85.00 | 1225452303 - MARTHA JEFFERSON HOSPITAL, MARTHA JEFFERSON OUTPATIENT SURGERY CENTER | 540261840 - (VA) MARTHA JEFFERSON HOSPITAL | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $75.00 | 1922566066 - DELMARVA ENDOSCOPY CENTER LLC | 831509115 - (MD) DELMARVA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $225.00 | 1023604931 - ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | 854282481 - (AZ) ADVANCED SPINE AND PAIN SURGERY CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $4613.00 | 1861657256 - INDIANA ENDOSCOPY CENTERS LLC | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51798 | $118.00 | 1013522127 - SARC BY HSH ASC PINE BLUFF, LLC, SARC BY HSH ASC PINE BLUFF LLC | 850884465 - (AR) SARC BY HSH ASC PINE BLUFF LLC | AR | 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 51798 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51798 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 51798 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 |
|---|---|---|
| 51741-CPT | Low | Complex Uroflowmetry-Eg,Calibrate Electr |
| 51784-CPT | Low | Electmygrph Study (Emg) Of Anal/Urthr Sphnctr, Oth Thn Needl, Any Tech |
| 51792-CPT | Moderate | Stimulus Evoked Response |
| 51798-CPT | Low | Measurement Of Post-Voiding Residual Urine And/Or Bladder Capacity By Ultrasound, Non-Imaging |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51798. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51798 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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