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See a sample rate comparisonCPT 51860 Fee Schedule
Last Verified: October 2026
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.
Cystorrhaphy Suture Of Bladder Wound Njury Or Rupture; Smple, Cystorrhaphy Suture Of Bladder Wound Injury Or Rupture; Simple
| 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 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 51860 |
| Medicaid Fee Schedule | View Medicaid rates for 51860 |
National average reimbursement for CPT 51860 by major payers:
$909.44
$999.45
$1,068.85
$1,214.28
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CPT 51860
5 of 25 sample ratesHigher to lower in this preview
Surgery Affiliate Of El Paso, LLC, Foundation Surgery Affiliate Of El Paso, LLC
Surgery Affiliate Of El Paso LLC
$8,791.00Published rateUrology Asc- Phoenix, LLC, Urologic Surgery Center Of Arizona
$2,388.00Published rateClearway Surgery Center Of Crestview, LLC
Clearway Surgery Center Of Crestview LLC
$1,300.00Published rateMid- America Surgery Center, LLC
Mid America Surgery Center LLC
$975.00Published rateG.I.Endoscopy Center
Giendoscopy Center
$390.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 51860 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51860 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 51860 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 |
|---|---|---|
| 51845-CPT | Moderate | Abdomino-Vaginal Vesical Neck, Abdomino-Vaginal Vesical Neck Suspension With Or Withoutendoscopic Control (Eg Stamey Raz Modified Pereyra) |
| 51860-CPT | Moderate | Cystorrhaphy Suture Of Bladder Wound Njury Or Rupture; Smple, Cystorrhaphy Suture Of Bladder Wound Injury Or Rupture; Simple |
| 51865-CPT | High | Cystorrhaphy Suture Of Bladder Wound Njury Or Rupture; Complic, Cystorrhaphy Suture Of Bladder Wound Injury Or Rupture; Complicated |
| 51900-CPT | High | Close Fistula Vesicovaginal Abd |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51860 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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