CPT 53431 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Urinary System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 62 - Co-Surgeons • 82 - Assistant surgeon - no qualified resident |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53431 |
National average reimbursement for CPT 53431 by major payers:
$1,409.63
$1,552.27
$1,591.23
$1,918.93
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 53431 | ||||||
United | 53431 | $1750.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $770.00 | 1508879446 - WEST FLORIDA SURGERY CENTER INC | 651092124 - (FL) WEST FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $1984.00 | 1689163875 - VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK, LLC | 825370300 - (IL) VASCULAR ACCESS CENTERS OF ILLINOIS AT MORGAN PARK LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $2300.00 | 1124484019 - EDISON SURGERY CENTER LLC | 475016492 - (NJ) EDISON SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $3139.00 | 1376634683 - MONTGOMERY SURGICAL CENTER, LTD | 752365748 - (AL) MONTGOMERY SURGICAL CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $1410.00 | 1871260224 - BARNET DULANEY PERKINS EYE CENTER, PC, VALLEY OUTPATIENT SURGERY CENTER | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $2393.00 | 1477655801 - CATARACT AND LASER CENTER ASSOCIATES PC | 43359062 - (MA) CATARACT AND LASER CENTER ASSOCIATES PC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $4600.00 | 1396742029 - GARLAND SURGICARE PARTNERS, LTD., BAYLOR SURGICARE AT GARLAND | 752764855 - (TX) GARLAND SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $1122.00 | 1336103001 - PERKINS PLAZA AMBULATORY SURGERY CENTER LLC, LAKE SURGERY CENTER | 481264699 - (LA) LAKE ASC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $2165.00 | 1861743601 - FLUSHING ENDOSCOPY CENTER, LLC | 274675522 - (NY) FLUSHING ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $4339.00 | 1609274505 - BAY AREA SURGICAL SPECIALIST SERVICES, LLC | 471556346 - (CA) BAY AREA SURGICAL SPECIALIST SERVICES LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $1357.00 | 1043204688 - INDIANA AMBULATORY SURGICAL ASSOCIATES, INC | 232923182 - (PA) INDIANA AMBULATORY SURGICAL ASSOCIATES INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $2900.00 | 1841255718 - PAOLI SURGERY CENTER LLC | 621547618 - (PA) PAOLI SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $1747.00 | 1023182581 - MAYS & SCHNAPP PAIN CLINIC & REHABILITATION CENTER | 621512849 - (TN) MAYS SCHNAPP PAIN CLINIC REHABILITATION CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53431 | $3623.00 | 1043605934 - SEASIDE SURGERY CENTER, LLC | 472399984 - (FL) SEASIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 53431 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53431 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 53431 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 |
|---|---|---|
| 53425-CPT | High | Urethroplasty Stg 2 |
| 53430-CPT | High | Urethroplas,Reconst.Female Urethra |
| 53431-CPT | High | Urethroplasty With Tubularization Of Posterior Urethra And/Or Lower Bladder For Incontinence (Eg, Tenago, Leadbetter Procedure) |
| 53445-CPT | High | Operation For Correction Of Urinary Incontinence With Placement Of Inflatable Urethral Or Bladder Neck Sphincter, Includ |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53431. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53431 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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