CPT 51999 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 • AS - Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) assistant at surgery services • 62 - Co-Surgeons |
| Complexity Level | High |
National average reimbursement for CPT 51999 by major payers:
$1,197.16
$596.77
$2,721.51
$13,362.00
| 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 51999 | ||||||
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CPT 51999 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 51999 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 51999 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 |
|---|---|---|
| 51999 | High | Other Procedure On Bladder Using An Endoscope |
| 52000 | Moderate | Cystourethroscopy (Separate Procedure) |
| 52001 | Moderate | Cystourethroscopy With Irrigation And Evacuation Of Clots |
| 52005 | Moderate | Cysto-Urethroscopy, With Ureteral Catheterization, With Or Without Irrigation, Instillation, Or Uretero-Pyelography, Exclusive Of Radiologic Service; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 51999. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 51999 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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