CPT 52351 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 52351 by major payers:
$425.50
$414.07
$451.63
$507.91
| 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 52351 | ||||||
United | 52351 | $1698.00 | 1073505038 - PALMETTO SURGERY CENTER LLC | 582333248 - (SC) PALMETTO SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $958.00 | 1194798959 - EAST PARIS SURGICAL CENTER, LLC | 421565886 - (MI) EAST PARIS SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1599.00 | 1285213009 - UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE, LLC, UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE | 372002744 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1403.00 | 1487782637 - EYEASSOCIATES SURGERY CENTER, INC | 581362384 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $900.00 | 1932298718 - OUTPATIENT SERVICES EAST | 630888861 - (AL) OUTPATIENT SERVICES EAST LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $544.48 | 1295713857 - ARTHUR BENTSEN | 350593390 - DEACONESS HOSPITAL INC | IN | Pulmonary Disease Physician (207RP1001X) |
United | 52351 | $771.00 | 1144291261 - OCEAN SURGICAL PAVILION, PC, OCEAN SURGICAL PAVILION | 223182653 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $250.16 | 1114766979 - TYLER UNFRIED | 350593390 - DEACONESS HOSPITAL INC | KY | Physician Assistant (363A00000X) |
United | 52351 | $5402.00 | 1457948630 - METHODIST AMBULATORY SURGERY CENTER OF LANDMARK, LLC | 842492174 - (TX) METHODIST AMBULATORY SURGERY CENTER OF LANDMARK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $587.00 | 1659683662 - PREMIER ENDOSCOPY CENTER, LLC | 272932575 - (AZ) PREMIER ENDOSCOPY CENTER, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1700.00 | 1881001212 - AMBULATORY SURGICAL CENTER AT BASKING RIDGE | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1380.00 | 1477886406 - BILTMORE SURGICAL PARTNERS, LLC, DEER VALLEY SURGICAL AND ENDOSCOPY CENTER | 264509307 - (AZ) BILTMORE SURGICAL PARTNERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $2307.00 | 1184687386 - DIGESTIVECARE, LLC, DIGESTIVECARE ENDOSCOPY UNIT | 311108485 - (OH) DIGESTIVE CARE, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $825.00 | 1891784955 - PLATTSBURGH ASC LLC, CATARACT CETNER FOR THE ADIRONDACKS | 141801168 - (NY) PLATTSBURGH ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1463.00 | 1104897644 - FOX VALLEY ORTHOPAEDIC ASSOCIATES, S.C., FOX VALLEY ORTHOPAEDIC AMBULATORY SURGICAL CENTER | 362796281 - FOX VALLEY ORTHOPAEDIC ASSOCIATES, S.C. | IL | 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 52351 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52351 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 52351 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) |
| 52351-CPT | Moderate | Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; Diagnostic |
| 52352-CPT | Moderate | Cystourethroscopy, With Ureteroscopy And/Or Pyeloscopy; With Removal Or Manipulation Of Calculus (Ureteral Catheterization Is Included) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52351. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52351 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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