CPT 53020 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 • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Low |
| CMS | $93.48 Physician Fee Schedule |
National average reimbursement for CPT 53020 by major payers:
$130.88
$139.85
$143.71
$166.56
| 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 53020 | ||||||
United | 53020 | $632.50 | 1962506618 - THE POLYCLINIC, ASC POLYCLINIC SURGERY CENTER | 910369070 - (WA) THE POLYCLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $1921.00 | 1114584786 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $1225.00 | 1205885746 - GLASGOW MEDICAL CENTER LLC, GLASGOW AMBULATORY SURGERY CENTER | 510320926 - (DE) GLASGOW MEDICAL CENTER, LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $2388.00 | 1174777817 - INDIANA SPECIALTY SURGERY CENTER, LLC, INDIANA SPECIALTY SURGERY CENTER | 364775143 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $4186.00 | 1063757227 - PARKVIEW ORTHO CENTER, LLC | 611697669 - (IN) PARKVIEW ORTHO CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $2353.00 | 1871032680 - OLIVE AMBULATORY SURGERY CENTER, LLC, NORTH CAMPUS SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $743.00 | 1760447866 - MOBILE-SC, LTD, MOBILE SURGERY CENTER | 630883553 | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $330.00 | 1932285871 - WASHINGTON OUTPATIENT SURGERY CENTER, LLC, WASHINGTON OUTPATIENT SURGERY CENTER | 930919267 - (CA) WASHINGTON OUTPATIENT SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $5177.00 | 1528121316 - SAINT LUKES SOUTH SURGERY CENTER LLC | 201721929 - (KS) SAINT LUKES SOUTH SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $1000.00 | 1831349406 - GASTROENTEROLOGY EAST, P.A. | 202964888 - (NC) GASTROENTEROLOGY EAST, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $2205.00 | 1164527933 - NORTHWEST AMBULATORY SURGERY SERVICES, LLC, BELLINGHAM AMBULATORY SURGERY CENTER | 911830115 - (WA) NORTHWEST AMBULATORY SURGERY SERVICES, LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $1540.00 | 1265486849 - FEATHERSTONE PARTNERSHIP LP, ROCKFORD AMBULATORY SURGERY CENTER | 363861021 - (IL) THE FEATHERSTONE PARTNERSHIP L. P. | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $330.00 | 1427134998 - HILL COUNTRY MEMORIAL SURGERY CENTER, LLC | 331039828 - (TX) HILL COUNTRY MEMORIAL SURGERY CE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $632.50 | 1669959151 - PRECISION SURGERY CENTER, LLC. | 831362479 - (TX) PRECISION SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53020 | $2388.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | 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 53020 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53020 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 53020 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53020 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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