CPT 53452 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53452 |
National average reimbursement for CPT 53452 by major payers:
$2,389.78
$517.32
$487.24
$657.87
| 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 53452 | ||||||
United | 53452 | $845.00 | 1245566744 - CHESTERFIELD ASC, LLC | 811166184 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $719.00 | 1477917151 - WHITE OAK SURGERY CENTER | 273885555 - (GA) WHITE OAK SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $2307.00 | 1053453134 - ADVANCED SURGICAL CONCEPTS LLC | 331035210 - (LA) ADVANCED SURGICAL CONCEPTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $2289.00 | 1710615869 - ORTHOILLINOIS SURGERY CENTER ELGIN, LLC | 851212739 - (IL) ORTHOILLINOIS SURGERY CENTER ELGIN LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1074.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $749.00 | 1417118407 - MSC AMBULATORY SURGICAL CENTER, LLC | 202155076 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $550.00 | 1801827993 - SOUTH CAROLINA ENDOSCOPY CENTER | 571125931 - (SC) SOUTH CAROLINA ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $2353.00 | 1699777540 - PHYSICIANS SURGERY CENTER OF TEMPE, LLC, PHYSICIANS SURGERY CENTER OF TEMPE | 731538769 - (AZ) PHYSICIANS SURGERY CENTER OF TEMPE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1011.00 | 1053505511 - DIGESTIVE DISEASE CENTER OF CENTRAL NEW YORK, LLC | 260531425 - (NY) DIGESTIVE DISEASE CENTER OF CENTRAL NEW YORK LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $2206.00 | 1780797910 - CRYSTAL CITIES SURGERY CENTER, TWIN CITIES SURGERY CENTER | 260839397 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1804.00 | 1912909433 - CENTENNIAL SURGUNIT, LLC, CENTENNIAL SURGERY CENTER | 223580847 - (NJ) CENTENNIAL SURGUNIT LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $2547.00 | 1831576891 - ADVANCED SURGERY CENTER PERIMETER, LLC | 473080613 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1306.00 | 1083050603 - CORTLAND ASC, LLC, CORTLAND SURGICAL CENTER | 461344196 - (NY) CORTLAND ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1520.00 | 1760947717 - ADVANCED ORTHOPAEDIC SURGERY CENTER, LLC, LAS VEGAS INSTITUTE FOR ADVANCED SURGERY | 832874360 - (NV) ADVANCED ORTHOPAEDIC SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53452 | $1020.00 | 1639615297 - SURGERY CENTER AT THE RESERVE, P.A., INC. | 814665763 - (AR) SURGERY CENTER AT THE RESERVE PA INC | AR | 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 53452 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53452 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 53452 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 |
|---|---|---|
| 53450-CPT | Moderate | Urethromeatoplasty W Mucosal Advanc |
| 53451-CPT | High | Periurethral Transperineal Adjustable Balloon Continence Device; Bilateral Insertion Including Cystourethroscopy And Imaging Guidance |
| 53452-CPT | High | Periurethral Transperineal Adjustable Balloon Continence Device; Unilateral Insertion, Including Cystourethroscopy And Imaging Guidance |
| 53453-CPT | High | Periurethral Transperineal Adjustable Balloon Continence Device; Removal Each Balloon |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53452. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53452 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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