CPT 53445 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • GC - Service performed by resident under supervision |
| Complexity Level | High |
| CMS | $737.82 Physician Fee Schedule |
National average reimbursement for CPT 53445 by major payers:
$1,002.70
$1,062.68
$1,151.86
$1,325.32
| 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 53445 | ||||||
United | 53445 | $10162.00 | 1962556076 - AK SURGERY CENTER, LLC | 203332833 - (CA) AK SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $5202.00 | 1538389812 - IRONBOUND ENDO SURGICAL CENTER, INC. | 223651393 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $7850.00 | 1871119107 - REGIONAL PLASTIC SURGERY CENTER PA, REGIONAL PLASTIC SURGERY CENTER - SHERMAN | 752365055 - (TX) REGIONAL PLASTIC SURGERY ASSOCIATES, P.A. | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $2797.00 | 1396213294 - UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | 831320776 - (OH) UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $13556.00 | 1447385158 - HARBIN CLINIC, LLC, HARBIN GI | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $10382.00 | 1427055425 - PHYSICIANS PAVILION LP, PHYSICIANS PAVILION SURGERY CENTER | 830619935 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $5230.00 | 1689633588 - SOUTH JERSEY ENDOSCOPY LLC, DIMARINO-KROOP-PRIETO GI ASSOC | 200478348 - (NJ) SOUTH JERSEY ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $11739.00 | 1447685458 - CHECKERSPOT SURGERY CENTERS, LLC | 463181931 - (MD) CHECKERSPOT SURGERY CENTERS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $5910.00 | 1235376104 - GASTROENTEROLOGY & SURGERY CENTER OF ARKANSAS, II, LLC. | 264039931 - (TN) GASTROENTEROLOGY SURGERY CENTER OF ARKANSAS II LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $928.00 | 1689657058 - CENTER FOR ADVANCED EYE SURGERY, LTD | 341866635 - (OH) CENTER FOR ADVANCED EYE SURGERY LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $2625.00 | 1679602544 - TGH SURGERY CENTER AT MORSANI, LLC, TGH SURGERY CENTER | 812203868 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $7357.00 | 1972675668 - TEXAS REGIONAL EYE CENTER ASC LLC, TEXAS REGIONAL EYE CENTER ASC LLC | 710967940 - (TX) TEXAS REGIONAL EYE CENTER ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $10999.00 | 1356124309 - SAINT LUKE'S NORTH SURGERY CENTER, LLC | 920591506 - (MO) SAINT LUKES NORTH SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $12000.00 | 1396089108 - TRIANGLE ORTHOPAEDICS SURGERY CENTER | 275268935 - (NC) TRIANGLE ORTHOPAEDICS SURGERY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53445 | $11030.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | 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 53445 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53445 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 53445 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 |
|---|---|---|
| 53440-CPT | High | Rep Incontinence Urinary Male |
| 53442-CPT | High | Remov Perineal Prosth.For Continenc |
| 53445-CPT | High | Operation For Correction Of Urinary Incontinence With Placement Of Inflatable Urethral Or Bladder Neck Sphincter, Includ |
| 53446-CPT | Moderate | Removal Of Inflatable Urethral/Bladder Neck Sphincter, Including Pump, Reservoir, And Cuff |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53445. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53445 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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