CPT 52265 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 52265 by major payers:
$465.74
$530.10
$541.66
$642.98
| 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 52265 | ||||||
United | 52265 | $330.00 | 1306956818 - WASHBURN SURGERY CENTER, LLC | 752748654 - (KS) WASHBURN SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $320.00 | 1265770572 - PHILADELPHIA SURGERY CENTER, INC. | 454790325 - (PA) PHILADELPHIA SURGERY CENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $819.50 | 1891865077 - REGENCY SURGERY CENTER, LLC | 710973677 - (CA) REGENCY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $500.00 | 1124277058 - DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER MOUNTAINSIDE | 582406657 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $282.00 | 1144650060 - SAN ANTONIO CHILDRENS SURGICAL | 464050149 - (TX) SAN ANTONIO CHILDRENS SURGICAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $613.00 | 1942265939 - INLAND SURGERY CENTER LP | 330018673 - (CA) INLAND SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $819.50 | 1558497263 - ARTHUR N DONALDSON M D INC, SONORA EYE SURGERY CENTER | 942593611 - ARTHUR N DONALDSON MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $248.00 | 1558416255 - VIRGIL V. WILLARD, II MD PA, CENTER FOR IMAGE DISCOVERY PA | 300399108 - (NC) VIRGIL V WILLARD II MD PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $2044.00 | 1902401748 - LANDMARK SURGICAL SUITES, LLC | 851130696 - (IN) LANDMARK SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $594.00 | 1972758183 - DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC | 260448163 - (CT) DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $704.00 | 1205845740 - THE UROLOGY CENTER LLC | 311579733 - (OH) THE UROLOGY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $227.00 | 1659360303 - ST JOHNS SURGERY CENTER LLC | 650502027 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $649.00 | 1164771762 - MARYLAND SPECIALTY SURGERY CENTER, LLC | 454793230 - (MD) MARYLAND SPECIALTY SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52265 | $655.33 | 1629097639 - DEACONESS HOSPITAL, INC., <UNAVAIL> | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 52265 | $1132.00 | 1780613521 - LITCHFIELD HILLS SURGERY CENTER | 562441789 - (CT) LITCHFIELD HILLS SURGERY CENTER | CT | 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 52265 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52265 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 52265 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 |
|---|---|---|
| 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) |
| 52265-CPT | Moderate | Cystoscopy W Dilation Local Anes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52265 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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