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 |
| CMS | $290.80 Physician Fee Schedule |
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 | $7169.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | 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 | 52351 | $544.48 | 1649547712 - OMAR RIVERA-RIVERA | 350593390 - DEACONESS HOSPITAL INC | PR | Family Medicine Physician (207Q00000X) |
United | 52351 | $2044.00 | 1740634369 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1200.00 | 1023373628 - EYES ON STARK SURGERY CENTER, LLC, VISTA SURGICAL CENTER | 451114025 - (OH) EYES ON STARK SURGERY CENTER, LLC DBA VISTA SURGICAL CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1658.00 | 1790265999 - MUVE | 822351627 - (PA) MUVE | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $607.00 | 1720023690 - BLUE WATER ASC LLC, BLUE WATER SURGERY CENTER, LLC | 383684085 - (MI) BLUE WATER ASC LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1968.00 | 1013539709 - BSC BILTMORE LLC | 850820003 - (AZ) BSC BILTMORE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1713.00 | 1265009005 - SURGCENTER NORTHERN PHOENIX LLC | 854160690 - (AZ) SURGCENTER NORTHERN PHOENIX LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $544.48 | 1295713857 - ARTHUR BENTSEN | 350593390 - DEACONESS HOSPITAL INC | IN | Pulmonary Disease Physician (207RP1001X) |
United | 52351 | $1025.00 | 1689604886 - SOUTH COUNTY OUTPATIENT SURGERY CENTER, LLC | 270133073 - (FL) SOUTH COUNTY OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1353.00 | 1093716037 - CATARACT AND REFRACTIVE SURGERY CENTER, LLC, NOVAMED SURGERY CENTER OF RICHMOND, LLC | 621865972 - (VA) CATARACT AND REFRACTIVE SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $1355.00 | 1295279586 - UNIVERSITY OF MIAMI, UMIAMI MEDICINE - OPHTHALMOLOGY (NAPLES BASCOM PALMER - ASC) | 592579938 - UNIVERSITY OF MIAMI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $867.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52351 | $2717.00 | 1114965803 - ADVANCED ENDOSCOPY & SURGICAL CENTER LLC, ADVANCED ENDOSCOPY & SURGICAL CENTER | 113660090 - (NJ) ADVANCED ENDOSCOPY SURGICAL CENTER LLC | NJ | 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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