CPT 52235 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • GC - Service performed by resident under supervision • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52235 |
National average reimbursement for CPT 52235 by major payers:
$370.95
$393.44
$431.87
$485.36
| 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 52235 | ||||||
United | 52235 | $2859.00 | 1063092047 - TAMPA BAY JOINT AND SPINE, LLC, TAMPA BAY JOINT AND SPINE SURGERY CENTER | 851259146 - (FL) TAMPA BAY JOINT AND SPINE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $1212.00 | 1366422370 - URLOGY AMBULATORY SURGERY CENTER LLC, WOLF RIVER SURGERY CENTER | 621828958 - (TN) URLOGY AMBULATORY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $986.00 | 1891754271 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, DIGESTIVE HEALTH NETWORK ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $1800.00 | 1649350844 - NORTHERN PLAINS SURGERY CENTER LLC | 450447247 - (ND) NORTHERN PLAINS SURGERY CENTER, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $3514.00 | 1427017987 - BAPTIST SURGERY CENTER LP, BAPTIST AMBULATORY SURGERY CENTER | 621672473 - (TN) BAPTIST SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $760.00 | 1043835713 - IDAHO ENDOSCOPY CENTER LLC, NAMPA IDAHO ENDOSCOPY CENTER | 270996353 - (ID) IDAHO ENDOSCOPY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $576.00 | 1811438997 - RATTNER VASCULAR MEDICAL CENTER ASC LLC | 815157265 - (CA) RATTNER VASCULAR MEDICAL CENTER ASC LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $443.00 | 1447472659 - BROCKTON ENDOSCOPY SURGERY CENTER LP | 61706315 - (CA) BROCKTON ENDOSCOPY SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $795.00 | 1306924170 - DELMAR SURGICAL CENTER LLC | 621717312 - (MD) DELMAR SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $2119.00 | 1316406523 - JOHNS HOPKINS SURGERY CENTERS SERIES, GREEN SPRING STATION SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $1021.00 | 1376159228 - COMPREHENSIVE SURGICAL CARE OF RENO-TAHOE, LLC | 851492944 - (NV) COMPREHENSIVE SURGICAL CARE OF RENOTAHOE LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $238.36 | 1760905632 - CLAIRE SUTHERBY | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Nurse Specialist (364S00000X) |
United | 52235 | $2271.00 | 1922141647 - RIVER NORTH SAME DAY SURGERY LLC, NORTHWESTERN MEDICINE SURGERY CENTER RIVER NORTH | 364091497 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $1062.00 | 1114980166 - NEW PORT RICHEY SURGERY CENTER LTD | 592907068 - (FL) NEW PORT RICHEY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52235 | $2388.00 | 1912378357 - DAVENPORT AMBULATORY SURGERY CENTER, L.L.C. | 881811228 | FL | 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 52235 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52235 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 52235 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 |
|---|---|---|
| 52224-CPT | Moderate | Cystourethroscopy, With Fulguration (Including Cryosurgery Or Laser Surgery) Or Treatment Of Minor (Less Than 0.5 Cm) Lesion(S) With Or Without Biopsy |
| 52234-CPT | Moderate | Cystourethroscopy, With Fulguration (Including Cryosurgery Or Laser Surgery) And/Or Resection Of; Small Bladder Tumor(S) (0.5 Up To 2.0 Cm) |
| 52235-CPT | Moderate | Cystourethroscopy, With Fulguration (Including Cryosurgery Or Laser Surgery) And/Or Resection Of; Medium Bladder Tumor(S) (2.0 To 5.0 Cm) |
| 52240-CPT | Moderate | Cystourethroscopy, With Fulguration (Including Cryosurgery Or Laser Surgery) And/Or Resection Of; Large Bladder Tumor(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52235 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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