CPT 52281 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • SG - Scene to Hospital ESRD facility |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52281 |
National average reimbursement for CPT 52281 by major payers:
$375.72
$418.85
$463.74
$535.10
| 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 52281 | ||||||
United | 52281 | $1276.00 | 1538126362 - WINTER HAVEN AMBULATORY SURGICAL CENTER LLC | 593659906 - (FL) WINTER HAVEN AMBULATORY SURGICAL CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $3256.00 | 1770788168 - TEXAS INSTITUTE FOR SURGERY, LLP, TEXAS INSTITUTE FOR SURGERY AT TEXAS HEALTH PRESBYTERIAN DALLAS | 770628004 - (TX) TEXAS INSTITUTE FOR SURGERY, LLP | TX | General Acute Care Hospital (282N00000X) |
United | 52281 | $928.00 | 1992238661 - OPTIMUM SURGICAL CENTER, LLC, NASCENT PARADISE VALLEY SURGICAL CENTER | 814730990 - (AZ) OPTIMUM SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $3256.00 | 1336172105 - TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | 756001743 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 52281 | $915.00 | 1366154304 - OPTUM CARE WASHINGTON PLLC, OPTUM - HELEN HOLM PUMPHREY SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $1258.00 | 1992713176 - DESERT RIDGE OUTPATIENT SURGERY LLC | 202528902 - (AZ) DESERT RIDGE OUTPATIENT SURGERY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $1114.00 | 1568489086 - MED ATLANTIC INC, MED ATLANTIC INC DBA UROSURGICAL CTR OF RICHMOND | 541759643 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $1809.00 | 1235509993 - PEDIATRIC AMBULATORY SURGERY CENTER SOUTHLAKE, CHILDRENSHEALTH SURGERY CENTER | 881391141 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $632.50 | 1336510486 - SACRAMENTO HEART AMBULATORY SURGERY CENTER, INC | 475284840 - (CA) SACRAMENTO HEART AMBULATORY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $1276.00 | 1831525112 - LONGLEAF SURGERY CENTER, LLC | 462421622 - (FL) LONGLEAF SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $431.00 | 1689843963 - PAIN-MDS AMBULATORY SURGICAL CENTER, LLC | 261980849 - (AZ) PAINMDS AMBULATORY SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $535.00 | 1154554160 - CABRILLO SURGERY CENTER | 270666008 - (CA) CABRILLO SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $1174.00 | 1154805646 - ANNE ARUNDEL-SCA SURGICENTER, LLC, AAMC SURGERY CENTER - ANNAPOLIS | 824763728 - (MD) ANNE ARUNDELSCA SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $2392.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 431704371 - FREEMAN HEALTH SYSTEM | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52281 | $445.00 | 1831195379 - LARGO SURGERY LLC, WEST BAY SURGERY CENTER | 10553657 - (FL) LARGO SURGERY LLC | 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 52281 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52281 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 52281 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 |
|---|---|---|
| 52275-CPT | Moderate | C-Uscopy W Int Urethrotomy Male |
| 52276-CPT | Moderate | Cystourethroscopy W Direc Vision Interna |
| 52277-CPT | Moderate | C-Uscopy W Sphincterotomy |
| 52281-CPT | Moderate | Cystourethroscopy, With Calibration And/Or Dilation Of Urethral Stricture Or Stenosis, With Or Without Meatotomy, With Or Without Injection Procedure For Cystography, Male Or Female |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52281. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52281 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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