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See a sample rate comparisonCPT 53275 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 Prolapse
| 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 GC - Service performed by resident under supervision 59 - Distinct Procedural Service AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 53275 |
| Medicaid Fee Schedule | View Medicaid rates for 53275 |
National average reimbursement for CPT 53275 by major payers:
$349.99
$356.12
$372.22
$431.85
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CPT 53275
5 of 25 sample ratesHigher to lower in this preview
Memorialcare Surgical Center At Saddleback LLC, Memorialcare Surgical Center Laguna Woods
$5,625.00Published ratePivac Asc LLC
$1,850.00Published rateGalleria Surgery Center LLC
$1,200.00Published rateWestern Washington Endoscopy Centers, LLC
Western Washington Endoscopy Centers LLC
$967.00Published rateGastroenterology Consultants Of Tuscaloosa Inc, Tuscaloosa Endoscopy Center
$100.00Published rate
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See a sample payer proposalCPT 53275 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53275 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 53275 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 |
|---|---|---|
| 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. |
| 53250-CPT | Moderate | Exc Bulbourethral Gland |
| 53265-CPT | Moderate | Exc/Fulgurate Urethral Caruncle |
| 53275-CPT | Moderate | Exc/Fulgurate Urethral Prolapse |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53275. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53275 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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