CPT 52343 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | Moderate |
| CMS | $330.26 Physician Fee Schedule |
National average reimbursement for CPT 52343 by major payers:
$494.17
$476.00
$475.82
$579.71
| 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 52343 | ||||||
United | 52343 | $2007.00 | 1275256562 - CARDIOVASCULAR ASSOCIATES SURGERY AND ELECTROPHYSIOLOGY LLC, CARDIOVASCULAR ASSOCIATES SURGERY AND ELECTROPHYSIOLOGY | 920358251 - CARDIOVASCULAR ASSOCIATES SURGERY AND ELECTROPHYSIOLOGY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $3277.00 | 1821528753 - KENNEDY CHERRY HILL SURGICAL CENTER LLC, JEFFERSON SURGERY CENTER - CHERRY HILL | 472462625 - (NJ) KENNEDY CHERRY HILL SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $3427.00 | 1316395270 - IRVINE SURGICAL PARTNERS LLC | 812776218 - (CA) IRVINE SURGICAL PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $2580.00 | 1871895821 - GWINNETT SURGERY CENTER, LLC | 272819709 - (GA) GWINNETT SURGERY CENTER,LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $1600.00 | 1629376207 - MARTEL EYE INSTITUTE LLC | 275350554 - (CA) MARTEL EYE INSTITUTE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $1370.00 | 1255397964 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $619.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $2859.00 | 1942617477 - CENTER FOR ENDOSCOPY LLC | 464958743 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $955.00 | 1811059306 - PENINSULA EYE CENTER, P.A, PENINSULA CATARACT & LASER CENTER | 520974706 - (MD) PENINSULA EYE CENTER PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $390.00 | 1982696894 - AFFILIATED AMBULATORY SURGERY CENTER LLC | 311719268 - (OH) AFFILIATED AMBULATORY SURGERY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $1475.00 | 1679858849 - THE EASTSIDE ENDOSCOPY CENTER, LLC | 911665997 - (WA) THE EASTSIDE ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $1472.00 | 1477619005 - SOUTHWEST IDAHO SURGERY CENTER, INC. | 841394136 - (ID) SOUTHWEST IDAHO SURGERY CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $6980.00 | 1104996768 - GREATER DAYTON SURGERY CENTER LLC | 202913367 - (OH) GREATER DAYTON SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $10263.29 | 1649392242 - ST. CLAIR MEMORIAL HOSPITAL | 251010303 - (PA) ST CLAIR HEALTH CORPORATION | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52343 | $1477.00 | 1891717195 - CENTER FOR PAIN MANAGEMENT LLC, TUCSON UROLOGIC SURGERY CENTER | 830962530 - (AZ) CENTER FOR PAIN MANAGEMENT LLC | AZ | 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 52343 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52343 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 52343 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 |
|---|---|---|
| 52341-CPT | Moderate | Cystourethroscopy; With Treatment Of Ureteral Stricture |
| 52342-CPT | Moderate | Cystourethroscopy; With Treatment Of Ureteropelvic Junction Stricture (Eg, Balloon Dilation, Laser, Electrocautery, And Incision) |
| 52343-CPT | Moderate | Cystourethroscopy; With Treatment Of Intra-Renal Stricture |
| 52344-CPT | Moderate | Cystourethroscopy With Ureteroscopy; With Treatment Of Ureteral Stricture (Eg, Balloon Dilation, Laser, Electrocautery, And Incision) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52343. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52343 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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