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See a sample rate comparisonCPT 53265 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 Urethral Caruncle
| 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 51 - Multiple procedures 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 53265 |
| Medicaid Fee Schedule | View Medicaid rates for 53265 |
National average reimbursement for CPT 53265 by major payers:
$287.69
$301.19
$317.81
$312.62
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CPT 53265
5 of 25 sample ratesHigher to lower in this preview
West Orange Asc LLC, Gregori Surgery Center
West Orange Asc LLC
$4,697.00Published rateGrand Avenue Surgery Center, LLC
Grand Avenue Surgery Center LLC
$2,606.00Published rateRockford Orthopedic Surgery Center, LLC
$2,289.00Published rateNorth Bend Medical Center Inc, Nbmc-Day Surgery
$1,211.00Published rateMesa Az Endoscopy Asc LLC, Desert Endoscopy Center
The Mesa Az Endoscopy Asc, LLC
$606.00Published rate
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See a sample payer proposalCPT 53265 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53265 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 53265 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 53265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53265 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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