CPT 52345 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| CMS | $377.81 Physician Fee Schedule |
National average reimbursement for CPT 52345 by major payers:
$543.42
$545.84
$572.62
$664.95
| 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 52345 | ||||||
United | 52345 | $1224.00 | 1053933952 - GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, P.A., KERNERSVILLE ENDOSCOPY CENTER | 561251665 - (NC) GASTROENTEROLOGY ASSOCIATES OF THE PIEDMONT, PA | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1750.00 | 1386795540 - THE SURGERY CENTER AT LONE TREE, LLC | 260139211 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $960.00 | 1912675513 - SUNRISE SURGERY CENTER LLC | 824678882 - (NY) SUNRISE SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $2901.00 | 1053418137 - TRI-CITY REGIONAL SURGERY CENTER LLC | 911728399 - (WA) TRI-CITY REGIONAL SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1035.00 | 1720270879 - AKSTEIN EYE CENTER, ASC, AKSTEIN EYE CENTER, ASC | 581597344 - (GA) AKSTEIN EYE CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $619.00 | 1891716767 - FEMI-CARE SURGERY CENTER, LLC | 710895222 - (MD) FEMICARE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1355.00 | 1265405203 - BLOOMFIELD EYE SURGERY CENTER LLC, THE EYE SURGERY CENTER | 621827592 - (CT) BLOOMFIELD EYE SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $814.00 | 1649957168 - BLUE ASH ENDOSCOPY CENTER, LLC | 931613837 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $2353.00 | 1295860302 - GOLD COAST SURGERY CENTER LLC, GULF COMPREHENSIVE SURGERY CENTER | 203958739 - (FL) GOLD COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1500.00 | 1801228481 - CENTER FOR SPINE INTERVENTIONS ASC 1 LLC | 462221027 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $2621.00 | 1275545279 - SURGERY CENTER OF COLUMBIA LP | 205227138 - (MO) SURGERY CENTER OF COLUMBIA LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $2859.00 | 1750565594 - PEDIATRIC SURGERY CENTER -ODESSA, LLC | 651274446 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $986.00 | 1427017813 - WESTERN WASHINGTON ENDOSCOPY CENTERS LLC, PENINSULA ENDOSCOPY CENTER | 200289310 - (WA) WESTERN WASHINGTON ENDOSCOPY CENTERS LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1391.00 | 1437101433 - TRI CITY SURGERY CENTER LLC | 201504745 - (AZ) TRI-CITY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52345 | $1011.00 | 1306214705 - GSI ASC, LLC | 474883816 - (OK) GSI ASC LLC | OK | 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 52345 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52345 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 52345 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 |
| 52345-CPT | Moderate | Cystourethroscopy With Ureteroscopy; With Treatment Of Ureteropelvic Junction 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 52345. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52345 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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