CPT 51820 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 |
| Common Modifiers | • None • 80 - Assistant surgeon • LT - Left side of body • AG - Primary physician |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 51820 |
National average reimbursement for CPT 51820 by major payers:
$1,326.95
$1,467.09
$1,524.03
$1,819.23
| 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 51820 | ||||||
United | 51820 | $675.00 | 1487198495 - SURGERY CENTER OF NAPLES, LLC | 812002107 - (FL) SURGERY CENTER OF NAPLES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $461.00 | 1225497019 - LANGLEY HOLDINGS, LLC | 473550370 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $651.00 | 1588332712 - HAND ASC LLC | 872342845 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $920.00 | 1053385328 - MIDWEST ENDOSCOPY SERVICES LLC | 470808172 - (NE) MIDWEST ENDOSCOPY SERVICES, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $520.00 | 1275542011 - NORTH CRESCENT SURGERY CENTER, L.L.C. | 201764601 - (GA) NORTH CRESCENT SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $514.00 | 1699748855 - MIDDLETOWN ENDOSCOPY ASC LLC, THE GI ENDOSCOPY CENTER | 621835826 - (OH) MIDDLETOWN ENDOSCOPY ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $405.00 | 1154301240 - ENDOSCOPY CENTER OF WASHINGTON DC LP, THE ENDOSCOPY CENTER OF WASHINGTON, D.C. | 621543524 - (DC) ENDOSCOPY CENTER OF WASHINGTON DC LP | DC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $1049.00 | 1528210770 - SOUTH COUNTY OUTPATIENT ENDOSCOPY SERVICES, LP, SCOPES ENDOSCOPY CENTER | 263374547 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $384.00 | 1750612446 - BAY SURGERY CENTERS, CLEARWAY SURGERY CENTER OF GLEN BURNIE | 271271303 - (MD) BAY SURGERY CENTERS | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $4300.00 | 1891881926 - GASTRO-SURGI CENTER OF NEW JERSEY | 223472632 - (NJ) GASTRO-SURGI CENTER OF NJ | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $1607.00 | 1386647527 - ORTHOPEDIC SURGERY CENTER OF OC LLC | 330841806 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $840.00 | 1679001028 - CENTERVIEW SURGERY CENTER, LLC | 815461133 - (AR) CENTERVIEW SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $1028.00 | 1396211264 - PALM BEACH SURGICAL SUITES LLC | 830558319 - (FL) PALM BEACH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $1274.00 | 1326114869 - EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC | 201482218 - (TX) EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $840.00 | 1407812860 - THE SURGICAL CENTER OF THE TREASURE COAST, LLC | 371446353 - (FL) SURGICAL CENTER OF THE TREASURE COAST | FL | 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 51820 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51820 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 51820 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 |
|---|---|---|
| 51715-CPT | Moderate | Endoscopic Injectn. Implant Material Into Tissues Of Ureth/Bladder Nec |
| 51720-CPT | Low | Bladder Instillation Anticarcinogenic Ag |
| 51800-CPT | High | Cystoplasty Or Cystourethroplasty, Plastic Operation On Bladder And/Or Vesical Neck (Anterior Y-Plasty, Vesical Fundus Resection), Any Procedure, With Or Without Wedge Resection Of Posterior Vesical Neck |
| 51820-CPT | High | Cystourethroplasty+Ureteroneocystos |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51820 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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