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 |
| CMS | $462.56 Physician Fee Schedule |
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 | $2282.00 | 1992497762 - SEATTLE SURGERY CENTER LLC | 882819593 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1400.00 | 1093842270 - NORTH GEORGIA EYE SURGERY CENTER LLC | 201510754 - (GA) NORTH GEORGIA EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1700.00 | 1700921251 - ELTRA LLC | 810598060 - (NJ) ELTRA LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $2388.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $673.00 | 1174571970 - DCR SURGERY CENTER, LLC | 200019313 - (OH) DCR SURGERY CENTER LLC | OH | 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 | $777.00 | 1922104710 - OAKS SURGERY CENTER LP | 753019861 - (CA) OAKS SURGERY CENTER LP THE OAK | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $814.00 | 1023123296 - ASSOCIATES SURGERY CENTERS, LLC | 510492139 - (PA) ASSOCIATES SURGERY CENTERS LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $940.00 | 1386603173 - EYE CARE SURGERY CENTER, INC | 721470732 - (LA) EYE CARE SURGERY CENTER INC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $3608.00 | 1093245458 - GREAT LAKES SURGICAL SUITES, LLC, GREAT LAKES SURGICAL SUITES | 821350843 - (IN) GREAT LAKES SURGICAL SUITES, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1223.00 | 1124526306 - INDIANA PAIN CENTERS-EVANSVILLE LLC | 823643604 - (IN) INDIANA PAIN CENTERSEVANSVILLE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $1339.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52400 | $7011.00 | 1184195877 - ALPINE SURGICENTER, LLC | 831318143 | AK | 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 | $2284.00 | 1063453561 - TEMPLETON SURGERY CENTER, LLC, TEMPLETON SURGERY CENTER | 202246616 - (CA) TEMPLETON SURGERY CENTER | CA | 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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