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See a sample rate comparisonCPT 53215 Fee Schedule
Last Verified: October 2026
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.
Remove Urine Tract, Surgery To Remove The Urethra (Tube That Drains The Bladder) And To Create An Opening Between The Bladder And Skin For Drainage Of Urine.
| 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 52 - Reduced Services GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53215 |
| Medicaid Fee Schedule | View Medicaid rates for 53215 |
National average reimbursement for CPT 53215 by major payers:
$1,177.93
$1,250.57
$1,295.37
$1,513.51
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CPT 53215
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$7,169.00Published rateRoswell Surgery Center LLC, Roswell Surgery Center
Roswell Surgery Center LLC
$2,388.00Published rateNei Ambulatory Surgery Center Inc PC
$1,125.00Published rateCenter For Spine & Pain Medicine, PC, Cspm Ambulatory Surgery
Center For Spine And Pain Medici
$806.00Published rateElkins Asc LLC, Gila Valley Procedure Center
Elkins Asc LLC
$475.00Published rate
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See a sample payer proposalCPT 53215 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53215 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 53215 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 |
|---|---|---|
| 53215-CPT | High | Remove Urine Tract, Surgery To Remove The Urethra (Tube That Drains The Bladder) And To Create An Opening Between The Bladder And Skin For Drainage Of Urine. |
| 53220-CPT | Moderate | Exc/Fulgurate Urethra Carcinoma |
| 53230-CPT | Moderate | Excis Urethral Diverticulum;Female |
| 53240-CPT | Moderate | Remove Pouch In Urine Tract, Surgery To Create An Opening In A Pouch Or Sac In The Bladder Canal (Urethra) For Drainage. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53215 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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