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See a sample rate comparisonCPT 53220 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.
Exc/Fulgurate Urethra Carcinoma
| 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 51 - Multiple procedures GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 53220 |
| Medicaid Fee Schedule | View Medicaid rates for 53220 |
National average reimbursement for CPT 53220 by major payers:
$553.25
$608.05
$621.70
$741.77
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CPT 53220
5 of 25 sample ratesHigher to lower in this preview
El Paso Surgery Centers Lp
$8,266.00Published rateAdvanced Spine Center Of Wisconsin, LLC
Advanced Spine Center Of Wisconsin
$3,570.00Published rateCares Surgicenter LLC
$1,848.00Published rateNational Park Endoscopy Center, LLC, South Central Endoscopy
National Park Endoscopy Center LLC
$1,009.00Published rateAssociated Urologists Ambulatory Surgery Center LLC
$663.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 53220 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53220 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 53220 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 |
|---|---|---|
| 53210-CPT | Moderate | 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. |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53220 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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