CPT 52005 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Urinary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 50 - Bilateral Procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52005 |
National average reimbursement for CPT 52005 by major payers:
$356.25
$385.13
$438.59
$475.04
| 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 52005 | ||||||
United | 52005 | $2353.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $819.50 | 1689699597 - NAPA SURGERY CENTER LLC | 680366295 - (CA) NAPA SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $1078.00 | 1598952061 - ENDOSCOPY ASSOCIATES, LLC | 142006705 - (VA) ENDOSCOPY ASSOCIATES LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $819.50 | 1912362955 - ST CHARLES SURGICAL CENTER | 474573964 - (CA) ST CHARLES SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $3150.00 | 1295702942 - GRAPEVINE SURGICARE PARTNERS LTD, BAYLOR SCOTT & WHITE SURGICARE - SOUTHLAKE | 752854711 - (TX) GRAPEVINE SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $3150.00 | 1124083076 - NORTH GARLAND SURGERY CENTER LLP, BAYLOR SCOTT & WHITE SURGICARE - NORTH GARLAND | 562399993 - (TX) NORTH GARLAND SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $2370.00 | 1669660817 - SPH IRVINE, L.L.C. | 752507129 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $1450.00 | 1225188808 - LOS ANGELES ENDOSCOPY CENTER, LOS ANGELES AMBULATORY SURGERY CENTER | 954775738 - (CA) LOS ANGELES ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $4831.00 | 1457379158 - HUDSON CROSSING SURGERY CENTER, LLC, HUDSON CROSSING SURGERY CENTER | 364533553 - (NJ) HUDSON CROSSING SURGICAL CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $2003.00 | 1578003208 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $1015.00 | 1073026639 - MID CITY SPECIALTY CENTER, LLC | 822996794 - (LA) MID CITY SPECIALTY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $2353.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $846.00 | 1710151063 - HENDI AMBULATORY SURGERY CENTER, PC | 262238944 - (MD) HENDI AMBULATORY SURGERY CENTER PC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $806.00 | 1669428983 - CENTER FOR SPINE & PAIN MEDICINE, PC, CSPM AMBULATORY SURGERY | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52005 | $715.00 | 1609983477 - NORTH GEORGIA ENDOSCOPY CENTER INC | 582070246 | GA | 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 52005 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52005 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 52005 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 |
|---|---|---|
| 51865-CPT | High | Cystorrhaphy Complicated |
| 52000-CPT | Moderate | Cystourethroscopy (Separate Procedure) |
| 52001-CPT | Moderate | Cystourethroscopy With Irrigation And Evacuation Of Clots |
| 52005-CPT | 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 52005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52005 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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