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See a sample rate comparisonCPT 53420 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.
Surgical Repair Of Urine Tract, Surgery To Open A Blockage Repair An Injury Or Correct A Prolapse (Bladder Slips Out Of Place). The Procedure Is Performed In Two Stages.
| 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 22 - Increased Procedural Services UB |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53420 |
| Medicaid Fee Schedule | View Medicaid rates for 53420 |
National average reimbursement for CPT 53420 by major payers:
$1,068.04
$1,128.31
$1,166.13
$1,370.52
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CPT 53420
5 of 25 sample ratesHigher to lower in this preview
West Orange Asc LLC, Gregori Surgery Center
West Orange Asc LLC
$5,015.00Published rateSurgcenter Of Bel Air
Surgcenter Of Bel Air, LLC
$2,490.00Published rateEye Surgery Center, Loren Barrus & Paul Schultz Ptrs
Eye Surgery Center
$1,924.00Published rateRedbird Square Endoscopy Center LLC, Digestive Health Center At Redbird Square
Redbird Square Endoscopy Center LLC
$1,376.00Published rateLiberty Endoscopy Center
Liberty Endoscopy Center, LLC
$860.00Published rate
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See a sample payer proposalCPT 53420 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53420 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 53420 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 |
|---|---|---|
| 53400-CPT | High | Urethroplasty; First Stage For Fistula Dverticulum Or Stricture, Urethroplasty; First Stage For Fistula Diverticulum Or Stricture (E |
| 53410-CPT | High | Urethroplas,1 Stg Recon-Male Urethr |
| 53415-CPT | High | Urethroplasty Transpubic Or P, Urethroplasty Transpubic Or Perineal One Stage Forreconstruction Or Repair Of Prostatic Or Membranous Urethra |
| 53420-CPT | High | Surgical Repair Of Urine Tract, Surgery To Open A Blockage Repair An Injury Or Correct A Prolapse (Bladder Slips Out Of Place). The Procedure Is Performed In Two Stages. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53420 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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