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See a sample rate comparisonCPT 51940 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.
Close Exstrophy
| 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 22 - Increased Procedural Services 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 51940 |
| Medicaid Fee Schedule | View Medicaid rates for 51940 |
National average reimbursement for CPT 51940 by major payers:
$2,055.31
$2,205.16
$2,289.06
$2,667.54
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CPT 51940
5 of 25 sample ratesHigher to lower in this preview
Indiana Endoscopy Centers LLC, Indiana Endoscopy Center West
$7,400.00Published rateDesert Vista Surgical Center LLC
$1,146.00Published rateWestern Washington Endoscopy Centers LLC, Puyallup Endoscopy Center
Western Washington Endoscopy Centers LLC
$690.00Published rateHermitage Endoscopy Center Inc
$514.00Published rateSun City Ophthalmology Asc LLC, Eye Institute At Boswell
Sun City Ophthalmology Assoc LLC
$104.00Published rate
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See a sample payer proposalCPT 51940 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51940 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 51940 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 |
| 51900-CPT | High | Close Fistula Vesicovaginal Abd |
| 51940-CPT | High | Close Exstrophy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51940. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51940 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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