CPT 52356 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 52356 by major payers:
$570.90
$566.21
$607.21
$704.48
| 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 52356 | ||||||
United | 52356 | $2147.91 | 1982939955 - LINDSAY HAMPSON | 943281657 | WA | Urology Physician (208800000X) |
United | 52356 | $587.50 | 1407937253 - JOHN PETTIT | 472435308 | WA | Urology Physician (208800000X) |
United | 52356 | $1186.01 | 1851719900 - ALEXANDER SKOKAN | 912047402 | WA | Urology Physician (208800000X) |
United | 52356 | $388.10 | 1598296709 - JEFFERY LIN | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | WA | Urology Physician (208800000X) |
United | 52356 | $1189.48 | 1639344534 - ALVARO LUCIONI | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Urology Physician (208800000X) |
United | 52356 | $1003.32 | 1972554277 - ERIK TORGERSON | 912073120 | WA | Urology Physician (208800000X) |
United | 52356 | $658.89 | 1972962165 - COWLITZ INDIAN TRIBE, COWLITZ INDIAN TRIBAL HEALTH SERVICES | 911265477 - (WA) COWLITZ INDIAN TRIBE | WA | Multi-Specialty Group (193200000X) |
United | 52356 | $844.41 | 1801912134 - KATHLEEN KIERAN | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Urology Physician (208800000X) |
United | 52356 | $827.83 | 1578768255 - ATREYA DASH | 271209674 | WA | Urology Physician (208800000X) |
United | 52356 | $19814.66 | 1497129696 - SWEDISH HEALTH SERVICES, SWEDISH PHYSICIAN DIVISION | 910433740 - (WA) SWEDISH HEALTH SERVICES | WA | Multi-Specialty Group (193200000X) |
United | 52356 | $603.33 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52356 | $814.63 | 1841274412 - KARNY JACOBY | 911932954 | WA | Urology Physician (208800000X) |
United | 52356 | $1861.26 | 1295120681 - TIMOTHY BLOOD | 954542847 | WA | Otolaryngology Physician (207Y00000X) |
United | 52356 | $989.53 | 1184106262 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE ORTHOPAEDICS AND SPORTS MEDICINE | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Multi-Specialty Clinic/Center (261QM1300X) |
United | 52356 | $975.44 | 1720166812 - EUGENE HONG | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Urology Physician (208800000X) |
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 52356 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52356 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 52356 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 |
|---|---|---|
| 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) |
| 52353-CPT | Moderate | Cystourethroscopy W Ureteroscpy&/Or Pyeloscopy; With Lithotripsy |
| 52356-CPT | Moderate | Cystourethroscopy With Ureteroscopy And/Or Pyeloscopy; With Lithotripsy Including Insertion Of Indwelling Ureteral Stent (Eg Gibbons Or Double-J Type) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52356. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52356 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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