CPT 52400 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 • GC - Service performed by resident under supervision • AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 52400 |
National average reimbursement for CPT 52400 by major payers:
$644.84
$659.69
$687.62
$809.78
| 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 52400 | ||||||
United | 52400 | $2285.00 | 1225648470 - UCSD AMBULATORY SURGERY CENTER, LLC | 261232189 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $850.00 | 1386794980 - NEW VISION CATARACT CENTER LLC, NEW VISION CATARACT CENTER | 61557487 - (CT) NEW VISION CATARACT CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $859.75 | 1609134006 - VICTORIA LAINE | 350593390 - DEACONESS HOSPITAL INC | MT | Internal Medicine Physician (207R00000X) |
United | 52400 | $2010.00 | 1053336602 - VIRGINIA EYE INSTITUTE INC, VIRGINIA EYE INSTITUTE SURGERY PAVILION | 541420580 - (VA) VIRGINIA EYE INSTITUTE INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $845.00 | 1588203723 - SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER, LLC | 832560085 - (AZ) SOUTHWEST CARDIOVASCULAR INTERVENTIONAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1243.00 | 1497851893 - CHINIKO LLC, EYE SURGERY CENTER | 931234805 - (OR) CHINIKO LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $7011.00 | 1184195877 - ALPINE SURGICENTER, LLC | 831318143 | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $3099.00 | 1235715996 - CENTRAL UTAH SURGICENTER, LLC | 862348485 - (UT) CENTRAL UTAH SURGICENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1109.00 | 1972923068 - TRUECARE SURGERY CENTER, LLC | 463892733 - (CA) TRUECARE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $3150.00 | 1245657840 - SURGCENTER OF PLANO LLC | 462873916 - (TX) SURGCENTER OF PLANO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1810.00 | 1174873780 - YORKVILLE ENDOSCOPY, LLC | 460857425 - (NY) YORKVILLE ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1345.00 | 1710290606 - GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER, GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | 271921975 - (GA) GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $859.75 | 1699841874 - RAMA CHILUKURI | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 52400 | $5594.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1710.00 | 1407206972 - HEART OF TEXAS SURGERY CENTER PLLC, WACO CENTER OF SURGICAL ARTS | 811843636 - (TX) HEART OF TEXAS SURGERY CENTER PLLC | TX | 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 52400 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52400 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 52400 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 |
| 52400-CPT | Moderate | Cysto-Urethroscopy, With Incision, Fulguration, Or Resection Of Congenital Posterior Urethral Valves, Or Congenital Obstructive Hypertrophic Mucosal Folds |
| 53000-CPT | Low | Urethrotomy/Ostomy Ext Pendulous |
| 53020-CPT | Low | Meatotomy Ex Infant Office |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52400 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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