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See a sample rate comparisonCPT 53400 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.
Urethroplasty; First Stage For Fistula Dverticulum Or Stricture, Urethroplasty; First Stage For Fistula Diverticulum Or Stricture (E
| 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 GC - Service performed by resident under supervision 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53400 |
| Medicaid Fee Schedule | View Medicaid rates for 53400 |
National average reimbursement for CPT 53400 by major payers:
$1,048.66
$1,076.30
$1,132.84
$1,304.79
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CPT 53400
5 of 25 sample ratesHigher to lower in this preview
Texas Health Surgery Center Southwest Fort Worth, LLC
Texas Health Surgery Center Southwest Fort Worth LLC
$6,342.00Published rateMiddle Tennessee Ambulatory Surgery Center, L.P.
Middle Tennessee Ambulatory Surgery Center Lp
$3,570.00Published rateCenter For Assisted Reproduction Laboratory And Surgery Center, Inc.
Center For Assisted Reproduction Laboratory And Surgery Center Inc
$2,010.00Published rateO'Fallon Surgical Center, LLC, Physicians Surgical Center
Ofallon Surgical Center LLC
$1,632.00Published rateSurgeyecare, Inc., Surgeyecare General Partnership
$957.00Published rate
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See a sample payer proposalCPT 53400 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53400 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 53400 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 |
|---|---|---|
| 53000-CPT | Low | Urethrotomy Or Urethrostomy Xtrnal (Sepa Proc); Pendulous, Urethrotomy Or Urethrostomy External (Separate Procedure); Pendulous |
| 53085-CPT | Moderate | Drain Excess Urine From Tissue, Surgery To Drain Urine That Has Passed Out Of The Urinary Tract Into The Surrounding Tissue. |
| 53200-CPT | Moderate | Biopsy Of Urethra |
| 53400-CPT | High | Urethroplasty; First Stage For Fistula Dverticulum Or Stricture, Urethroplasty; First Stage For Fistula Diverticulum Or Stricture (E |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53400. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53400 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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