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See a sample rate comparisonCPT 53451 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.
Periurethral Tprnl Adjtbl Balo Cntnc Dev Bi Insj, Periurethral Transperineal Adjustable Balloon Continence Device; Bilateral Insertion Including Cystourethroscopy And Im
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 82 - Assistant surgeon - no qualified resident 80 - Assistant surgeon |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53451 |
| Medicaid Fee Schedule | View Medicaid rates for 53451 |
National average reimbursement for CPT 53451 by major payers:
$3,511.55
$1,026.38
$883.53
$1,326.78
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CPT 53451
5 of 25 sample ratesHigher to lower in this preview
Iu Health Arnett Hospital, Inc, Arnett Surgery Center, LLC
Indiana University Health Arnett Inc
$16,096.00Published rateRose Ambulatory Surgery Center Lp
$9,442.00Published rateSt Joseph Center For Outpatient Surgery, LLC
St Joseph Center For Outpatient Surgery LLC
$4,887.00Published rateComprehensive Surgical Center Of Green, LLC
Comprehensive Surgical Center Of Green LLC
$1,750.00Published ratePremier Endoscopy Center LLC
$383.00Published rate
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See a sample payer proposalCPT 53451 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53451 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 53451 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 |
|---|---|---|
| 53451-CPT | High | Periurethral Tprnl Adjtbl Balo Cntnc Dev Bi Insj, Periurethral Transperineal Adjustable Balloon Continence Device; Bilateral Insertion Including Cystourethroscopy And Im |
| 53452-CPT | High | Periurethrl Tprnl Adjtbl Balo Cntnc Dev Uni Insj, Periurethral Transperineal Adjustable Balloon Continence Device; Unilateral Insertion Including Cystourethroscopy And I |
| 53453-CPT | High | Remove Incontinence Device, Surgery To Remove An Implanted Device In The Tissue Surrounding The Urethra Used To Treat Urinary Incontinence. |
| 53454-CPT | Low | Periurethral Tprnl Adjtbl Balo Cntnc Dev Adjmt, Periurethral Transperineal Adjustable Balloon Continence Device; Percutaneous Adjustment Of Balloon(S) Fluid Volume |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53451. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53451 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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