CPT 52240 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 • 22 - Increased Procedural Services |
| Complexity Level | Moderate |
| CMS | $375.22 Physician Fee Schedule |
National average reimbursement for CPT 52240 by major payers:
$537.12
$582.35
$628.87
$694.61
| 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 52240 | ||||||
United | 52240 | $537.00 | 1225225592 - WESTERN CAROLINA ENDOSCOPY CENTER, LLC | 562593197 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $2859.00 | 1316291867 - PACIFIC ENDOSCOPY LLC, ATHERTON ENDOSCOPY CENTER | 460842370 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $1868.00 | 1003860917 - SURGERY CENTER OF PINEHURST, LLC | 680561185 - (NC) SURGERY CENTER OF PINEHURST LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $819.50 | 1588668503 - MIRAGE ENDOSCOPY CENTER, L.P. | 542077130 - (CA) MIRAGE ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $825.00 | 1558328518 - BUTLER AMBULATORY SURGERY CENTER L L C | 61728190 - (PA) BUTLER AMBULATORY SURGERY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $1078.00 | 1982626974 - PHYSICIANS EYE SURGERY CENTER, INC | 911320378 - (WA) PHYSICIANS EYE SURGERY CENTER INC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $1248.00 | 1710081443 - VENTURA ENDOSCOPY CENTER LLC | 680543503 - (CA) VENTURA ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $819.50 | 1487629986 - SAN LUIS OBISPO CA ENDOSCOPY ASC LP, ENDOSCOPY CENTER OF THE CENTRAL COAST | 201965605 - (CA) SAN LUIS OBISPO CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $1500.00 | 1467833160 - AUSTELL SURGERY CENTER, LLC | 473077378 - (GA) AUSTELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $324.29 | 1831374099 - ALYSEN WEINZAPFEL | 350593390 - DEACONESS HOSPITAL INC | IN | Acute Care Nurse Practitioner (363LA2100X) |
United | 52240 | $3292.68 | 1124022595 - THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS, LLC, SURGERY CENTER CEDAR RAPIDS | 721550812 - (IA) THE OUTPATIENT SURGERY CENTER OF CEDAR RAPIDS LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $7169.00 | 1346235058 - EAST MEQUON SURGERY CENTER LLC | 861075286 - (WI) EAST MEQUON SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $819.50 | 1144673526 - MURRIETA VALLEY SURGERY CENTER, INC.A PROFESSIONAL CORPORATION | 813020819 - (CA) MURRIETA VALLEY SURGERY CENTER INCA PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $3500.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52240 | $1530.00 | 1457460248 - OSC LLC, OMAHA SURGICAL CENER | 470693440 - (NE) OSC LLC | NE | 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 52240 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52240 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 52240 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 52240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52240 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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