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See a sample rate comparisonCPT 53040 Fee Schedule
Last Verified: October 2026
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.
Drain Urine Tract Infection, Surgery To Drain An Abscess (Pocket Of Pus) In The Urinary Tract. The Abscess Is The Result Of An Infection Or Injury.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 58 - Staged or related procedure during postoperative period 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 53040 |
| Medicaid Fee Schedule | View Medicaid rates for 53040 |
National average reimbursement for CPT 53040 by major payers:
$533.60
$538.71
$545.26
$649.76
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CPT 53040
5 of 25 sample ratesHigher to lower in this preview
Mclean Ambulatory Surgery, LLC
Mclean Ambulatory Surgery LLC
$4,623.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$2,044.00Published rateAsc Development Company LLC
$1,283.00Published rateRegional Urology Asc LLC
$982.00Published rateDelta Endoscopy Center, P.C.
Delta Endoscopy Center PC
$1.00Published rate
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See a sample payer proposalCPT 53040 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53040 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 53040 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 |
|---|---|---|
| 53010-CPT | Moderate | Urethrotomy Or Urethrostomy Xtrnal (Sepa Proc); Perineal, Urethrotomy Or Urethrostomy External (Separate Procedure); Perineal U |
| 53020-CPT | Low | Meatotomy Ex Infant Office |
| 53025-CPT | Low | Meatotomy Infant |
| 53040-CPT | Moderate | Drain Urine Tract Infection, Surgery To Drain An Abscess (Pocket Of Pus) In The Urinary Tract. The Abscess Is The Result Of An Infection Or Injury. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53040 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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