CPT 52649 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • GC - Service performed by resident under supervision • 22 - Increased Procedural Services |
| Complexity Level | High |
| CMS | $801.87 Physician Fee Schedule |
National average reimbursement for CPT 52649 by major payers:
$1,052.97
$1,166.95
$1,242.91
$1,432.64
| 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 52649 | ||||||
United | 52649 | $2109.00 | 1639456973 - PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC, POSC OF ABQ LLC | 273193930 - (NM) PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $6506.00 | 1275870537 - GCSA AMBULATORY SURGERY CENTER, LLC | 611699459 - (TX) GCSA AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $4113.00 | 1336790237 - AURORA ENDOSCOPY SURGICENTER, LLC | 825396997 - (CO) AURORA ENDOSCOPY SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $729.00 | 1649244567 - LAKELAND FL ENDOSCOPY ASC LLC, SURGERY CENTER OF LAKELAND HILLS BOULEVARD | 200288888 - (FL) LAKELAND FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $5354.00 | 1790252864 - TREASURE COAST ASC, LLC, TREASURE COAST CENTER FOR SURGERY | 384092821 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $1538.00 | 1992701049 - NORTHWEST FLORIDA SURGERY CENTER | 593123289 - (FL) NORTHWEST FLORIDA SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $383.00 | 1629262811 - PREMIER ENDOSCOPY CENTER LLC | 205055187 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $2801.00 | 1497706626 - CHICAGO PROSTATE CANCER SURGERY CENTER, LLC, DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT | 204403852 - (IL) CHICAGO PROSTATE CANCER SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $1246.00 | 1346596566 - SCP INDIANAPOLIS LLC | 460639908 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $5249.00 | 1518154517 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $4601.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $3712.00 | 1316379647 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC, MINNESOTA EYE LASER & SURGERY CENTERS | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $2012.00 | 1932183266 - SINGLE DAY SURGERY CENTER LLC | 880504513 - (NV) SINGLE DAY SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $2019.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 52649 | $3824.00 | 1518920040 - COUNTRYSIDE SURGERY CENTER, LTD | 752400186 - (FL) COUNTRYSIDE SURGERY CENTER LTD | FL | 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 52649 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 52649 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 52649 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 |
|---|---|---|
| 52601-CPT | Moderate | Transurethral Electrosurgical Resection Of Prostate, Including Control Of Postoperative Bleeding, Complete (Vasectomy, Meatotomy, Cystourethroscopy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy Are Included) |
| 52630-CPT | Moderate | Transurethral Resection; Residual Or Regrowth Of Obstructive Prostate Tissue Including Control Of Postoperative Bleeding, Complete (Vasectomy, Meatotomy, Cystourethroscopy, Urethral Calibration And/Or Dilation, And Internal Urethrotomy Are Included) |
| 52640-CPT | Moderate | Txureth.Resec;Postop.B.N.Contractur |
| 52649-CPT | High | Laser Enucleation Of The Prostate With Morcellation Including Control Of Postoperative Bleeding Complete (Vasectomy Meatotomy Cystourethroscopy Urethral Calibration And/Or Dilation Internal Urethrotomy & Transurethral Resection Of Prostate Are Included If Performed) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 52649. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 52649 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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