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See a sample rate comparisonCPT 51920 Fee Schedule
Last Verified: October 2026
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.
Repair Bladder Passage, Surgery To Repair An Abnormal Passage (Fistula) In The Uterus. The Procedure May Include Removal Of The Uterus (Hysterectomy).
| 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 78 - Return to OR - related procedure AS - PA/NP/CNS assistant at surgery GC - Service performed by resident under supervision 52 - Reduced Services 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 51920 |
| Medicaid Fee Schedule | View Medicaid rates for 51920 |
National average reimbursement for CPT 51920 by major payers:
$1,002.56
$1,032.78
$1,070.95
$1,253.24
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CPT 51920
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers, LLC, Saxony Surgery Center
$8,705.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Scottsdale
Surgery Center Of Scottsdale LLC
$2,353.00Published rateCreekside Surgery Suite
Shahriar Mabourakh, M.D.
$1,522.00Published rateBaltimore Endoscopy Asc LLC, Gastrointestinal Diagnostic Center
Baltimore Endoscopy Asc LLC
$1,070.00Published rateSpokane Digestive Disease Center, P.S., South Asc
Spokane Digestive Disease Center P.S.
$527.00Published rate
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See a sample payer proposalCPT 51920 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51920 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 51920 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 |
|---|---|---|
| 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 |
| 51920-CPT | High | Repair Bladder Passage, Surgery To Repair An Abnormal Passage (Fistula) In The Uterus. The Procedure May Include Removal Of The Uterus (Hysterectomy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51920. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51920 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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