CPT 53449 Fee Schedule
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.
| 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 • 78 - Return to OR - related procedure • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
| CMS | $598.41 Physician Fee Schedule |
National average reimbursement for CPT 53449 by major payers:
$810.29
$823.11
$845.81
$1,026.91
| 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 53449 | ||||||
United | 53449 | $950.00 | 1013341734 - CENTER FOR PAIN AND SPINE, LLC | 463285029 - (GA) CENTER FOR PAIN AND SPINE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $1624.00 | 1194233189 - CHAPIN ORTHOPEDIC SURGERY CENTER | 473916029 - (SC) CHAPIN ORTHOPEDIC SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $4774.00 | 1184195877 - ALPINE SURGICENTER, LLC | 204038061 | AK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $1099.16 | 1891224200 - KYLE KOPATICH | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 53449 | $2102.00 | 1275597056 - SURGERY CENTER OF ROME, LP | 200390305 - (GA) SURGERY CENTER OF ROME LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $656.83 | 1013553197 - AMY MOORE | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Acute Care Nurse Practitioner (363LA2100X) |
United | 53449 | $3217.00 | 1861931263 - METHODIST CRAIG RANCH SURGERY CENTER LLC | 352583971 - (TX) METHODIST CRAIG RANCH SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $2198.00 | 1245988955 - PALM BEACH REGIONAL OPCO LLC | 874629018 - (FL) PALM BEACH REGIONAL OPCO LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $1975.00 | 1114549987 - SAN LUIS WALK-IN CLINIC, INC., SAN LUIS OUTPATIENT SURGERY CENTER | 651170616 - (AZ) SAN LUIS WALK-IN CLINIC INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $1217.00 | 1740413400 - ATLANTIC SURGERY & LASER CENTER LLC | 262041000 - (FL) ATLANTIC SURGERY LASER CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $1893.00 | 1871557652 - PORT ST LUCIE SURGERY CENTER LTD | 621600419 - (FL) PORT ST LUCIE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $3623.00 | 1922611714 - COLORADO UROLOGIC SURGERY CENTER LLC | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $2020.00 | 1578918124 - CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | 811657416 - (ND) CENTER FOR PAIN MEDICINE SURGERY CENTER LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $897.00 | 1780651075 - FOX EYE SURGERY, LLC, FIRST CHOICE SURGERY CENTER | 202126099 - (IA) FOX EYE SURGERY LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53449 | $505.01 | 1144892795 - JONATHAN CUNNINGHAM | 350593390 - DEACONESS HOSPITAL INC | PA | Certified Registered Nurse Anesthetist (367500000X) |
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 53449 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53449 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 53449 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 |
| 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 |
| 53449-CPT | Moderate | Surg.Correct-Hydraulic Abnorm-Sphin |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53449. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53449 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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