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 |
| CMS | $1,052.23 Physician Fee Schedule |
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 | $531.00 | 1861418378 - MAPLEWOOD AMBULATORY SURGERY CENTER, INC. | 752730666 - (TX) MAPLEWOOD AMBULATORY SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $2069.00 | 1114924685 - SOUTH KANSAS CITY SURGICAL CENTER, LC, SOUTH KANSAS CITY SURGICENTER | 202181884 - (KS) SOUTH KANSAS CITY SURGICAL CENTER, LLC | KS | 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 | $3500.00 | 1538164546 - SURGERY CENTER AT PELHAM, LLC | 760745215 - (SC) SURGERY CENTER AT PELHAM, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $695.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $322.00 | 1194798959 - EAST PARIS SURGICAL CENTER, LLC | 421565886 - (MI) EAST PARIS SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $651.00 | 1588332712 - HAND ASC LLC | 872342845 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $581.00 | 1992384739 - SURGERY CENTER OPERATIONS, LLC | 851921698 - (FL) SURGERY CENTER OPERATIONS LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $571.00 | 1346205176 - CORAL DESERT SURGERY CENTER LLC | 710875262 - (UT) CORAL DESERT SURGERY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $983.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $1064.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | 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 | $874.00 | 1528145778 - OVERLAKE AMBULATORY SURGERY CENTER, LLC, OVERLAKE SURGERY CENTER LLC | 911925618 - (WA) OVERLAKE AMBULATORY SURGERY CENTER, | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $465.00 | 1255911970 - PINNACLE SURGERY CENTER | 842367400 - (LA) PINNACLE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 51820 | $983.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | 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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