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See a sample rate comparisonCPT 52204 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.
Bladder Exam With Biopsy, A Bladder Exam Using A Scope (Cystourethroscope). The Procedure Includes Taking A Sample Of Tissue For Testing (Biopsy).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52204 |
| Medicaid Fee Schedule | View Medicaid rates for 52204 |
National average reimbursement for CPT 52204 by major payers:
$453.96
$539.53
$588.88
$270.84
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CPT 52204
5 of 25 sample ratesHigher to lower in this preview
Indiana University Health Saxony Surgery Center LLC, Saxony Surgery Center
$8,705.00Published rateGardendale Surgical Associates, LLC
Gardendale Surgical Associates
$2,307.00Published rateMedical Eye Associates, Inc.
$1,275.00Published rateNorthway Spc LLC
Northway Spc, LLC D/B/A Northway Surgery And Pain Center
$859.00Published rateSurgery Center At Gateway LLC
$490.00Published rate
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See a sample payer proposalCPT 52204 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52204 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 52204 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 |
|---|---|---|
| 51940-CPT | High | Close Exstrophy |
| 51960-CPT | High | Enterocystoplasty W Bowel Anastomosis |
| 52007-CPT | Moderate | Cystoscopy And Biopsy, Cystourethroscopy With Ureteral Catheterization With Or Without Irrigation Instillation Or Ureteropyelography Exclusive Of Radiologic Service With Brush Biopsy Of Ureter And Or Renal Pelvis |
| 52204-CPT | Moderate | Bladder Exam With Biopsy, A Bladder Exam Using A Scope (Cystourethroscope). The Procedure Includes Taking A Sample Of Tissue For Testing (Biopsy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52204. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52204 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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