CPT 52285 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 |
| Medicare Fee Schedule | View Medicare rates for 52285 |
National average reimbursement for CPT 52285 by major payers:
$386.05
$410.85
$453.88
$550.59
| 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 52285 | ||||||
United | 52285 | $632.50 | 1144970807 - MEDICAL CITY SURGERY CENTER SOUTHLAKE, LLC | 881391141 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $632.50 | 1992752794 - SIERRA EYE AMBULATORY SURGERY CENTER, LLC | 770509889 - (CA) SIERRA EYE AMBULATORY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $1179.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $820.00 | 1659807717 - TAMPA SURGICAL CENTER LLC | 820715188 - (CA) TAMPA SURGICAL CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $1000.00 | 1356080642 - LEGENT OUTPATIENT SURGERY SINGING HILLS, LLC, LEGENT OUTPATIENT SURGERY SINGING HILLS | 861677359 - (TX) LEGENT OUTPATIENT SURGERY SINGING HILLS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $394.00 | 1265455463 - THE ENDOSCOPY CENTER AT BEL AIR | 470863243 - (MD) THE ENDOSCOPY CENTER AT BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $980.00 | 1295906956 - THE ENT CENTER OF RHODE ISLAND LLC, THE SURGERY CENTER OF RHODE ISLAND | 260329297 - (RI) THE ENT CENTER OF RHODE ISLAND | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $1200.00 | 1023072824 - SOUTH JERSEY EYE PHYSICIANS, LLC, THE SURGICAL CENTER AT SOUTH JERSEY EYE PHYSICIANS, PA | 222116946 - (NJ) SOUTH JERSEY EYE PHYSICIANS, PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $840.00 | 1760963292 - COLONIAL OUTPATIENT SURGERY CENTER, LLC | 831529015 - (FL) COLONIAL OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $414.00 | 1710952130 - MARYLAND ENDOSCOPY CENTER LLC, MARYLAND ENDOSCOPY CENTER | 521888989 - (MD) MARYLAND ENDOSCOPY CENTER, LLC. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $245.94 | 1811377153 - THANHTAM NGUYEN | 350593390 - DEACONESS HOSPITAL INC | TX | Certified Registered Nurse Anesthetist (367500000X) |
United | 52285 | $1179.00 | 1215548524 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $2575.00 | 1083776314 - CROZER-CHESTER MEDICAL CENTER | 811507712 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $1179.00 | 1558879684 - DELAWARE RIVER SURGICAL SUITES, LLC | 822713553 - (PA) BUCKS COUNTY SURGICAL SUITES | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52285 | $854.00 | 1770572307 - BETHESDA SURGERY CENTER, LLC | 522080005 - (MD) BETHESDA SURGERY CENTER LLC | MD | 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 52285 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52285 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 52285 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 |
|---|---|---|
| 52276-CPT | Moderate | Cystourethroscopy W Direc Vision Interna |
| 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 |
| 52282-CPT | Moderate | Insertion Of A Permanent Bladder Canal (Urethra) Stent Using An Endoscope |
| 52285-CPT | Moderate | Cystourethroscopy For Treatment Of The Female Urethral Syndrome With Any Or All Of The Following: Urethral Meatotomy Urethral Dilation Internal Urethrotomy Lysis Of Urethrovaginal Septal Fibrosis Lateral Incisions Of The Bladder Neck And Fulguration Of Polyp(S) Of Urethra Bladder Neck And/Or Trigone |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52285 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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