CPT 52315 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 • 58 - Staged or related procedure during postoperative period • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52315 |
National average reimbursement for CPT 52315 by major payers:
$548.77
$607.34
$664.82
$764.02
| 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 52315 | ||||||
United | 52315 | $1821.00 | 1679108914 - PRECISION SC, LLC, PRECISIONCARE SURGERY CENTER | 832882696 - (NY) PRECISION SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $819.50 | 1053328781 - LOS ALAMITOS SURGERY CENTER L P | 550823348 - (CA) LOS ALAMITOS SURGERY CENTER L P | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $1059.00 | 1255309951 - BAYFRONT SAME DAY SURGERY CENTER, LLC. | 845074208 - (FL) OHI WEST INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $2388.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $2529.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $754.00 | 1033292214 - PIKES PEAK ENDOSCOPY AND SURGERY CENTER, LLC | 841379009 - (CO) PIKES PEAK ENDOSCOPY AND SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $875.00 | 1386793370 - SURGERY CENTER OF WEST MONROE, LLC | 721509507 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $1650.00 | 1154839678 - R&R SURGICAL INSTITUTE | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $1540.00 | 1518423672 - PACIFIC RITZ SURGERY CENTER, LLC | 823738789 - (CA) PACIFIC RITZ SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $544.00 | 1497831523 - BOSTON IVF, INC., THE SURGERY CENTER OF WALTHAM | 42921956 - (MA) BOSTON IVF, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $1180.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 541052755 - (VA) VIRGINIA EAR, NOSE & THROAT ASSOCIATES, P.C. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $2795.00 | 1962568543 - ENDOSCOPY CENTER OF OCEAN COUNTY, LLC | 223461117 - (NJ) ENDOSCOPY CENTER OF OCEAN COUNTY, PC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $1200.00 | 1497220412 - PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC, PROVIDENCE ACCESS CARE | 453631706 - (RI) PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $858.00 | 1417190935 - MID-FLORIDA ENDOSCOPY & SURGERY CENTER LLC | 263388221 - (FL) MID-FLORIDA ENDOSCOPY & SURGER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52315 | $780.46 | 1609134006 - VICTORIA LAINE | 350593390 - DEACONESS HOSPITAL INC | MT | Internal Medicine Physician (207R00000X) |
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 52315 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52315 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 52315 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 |
|---|---|---|
| 52300-CPT | Moderate | Cystourethro;Resec Ureterocel,Un/Bi |
| 52301-CPT | Moderate | Cystourethroscopy; With Resection Or Fulguration Of Ectopic Ureterocel |
| 52305-CPT | Moderate | Cystoscopy W Inc/Exc Diverticulum |
| 52315-CPT | Moderate | Cystourethroscopy, With Removal Of Foreign Body, Calculus, Or Ureteral Stent From Urethra Or Bladder (Separate Procedure); Complicated |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52315 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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