CPT 53454 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 50 - Bilateral Procedure |
| Complexity Level | Low |
National average reimbursement for CPT 53454 by major payers:
$79.12
$31.91
$50.95
$126.31
| 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 53454 | ||||||
United | 53454 | $383.00 | 1992706840 - AMBULATORY SURGERY CENTER OF BURLEY, LLC | 820502971 - (ID) AMBULATORY SURGERY CENTER OF BURLEY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $65.00 | 1134499684 - CHILDRENS SURGERY CENTER OF MALVERN, LLC | 452608984 - (PA) CHILDRENS SURGERY CENTER OF MALVERN LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $100.00 | 1316484447 - CAPITAL CHILDREN'S HEALTHCARE | 812837189 - (MD) CAPITAL CHILDRENS HEALTHCARE | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $95.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $566.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $200.00 | 1750892659 - NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | 821651821 - (NC) NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $441.00 | 1306249453 - MARK FROMER, LLC, EYE SURGERY CENTERS OF NEW YORK | 274212773 - (NY) MARK FROMER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $917.00 | 1326136177 - TEANECK GASTROENTEROLOGY&ENDOSCOPY CENTER | 223348806 - (NJ) TEANECK GASTROENTEROLOGYENDOSCOPY CENTER | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $1268.00 | 1497244149 - HOSPITAL FOR SPECIAL SURGERY WEST SIDE AMBULATORY SURGERY CENTER, LLC, HSS WEST SIDE ASC, LLC | 814351390 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $3209.00 | 1326046822 - SOUTH EMERSON SURGERY CENTER, LLC | 352087260 - (IN) SOUTH EMERSON SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $544.00 | 1467415513 - LAS VEGAS SURGICARE LTD | 880244070 - (NV) LAS VEGAS SURGICARE LTD | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $150.00 | 1679595680 - SURGERY CENTER OF LEBANON, LP, PHYSICIANS SURGICAL CENTER | 721588584 - (PA) SURGERY CENTER OF LEBANON LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $207.00 | 1912267592 - SURGCENTER AT NATIONAL HARBOR, LLC, HARBORSIDE SURGERY CENTER | 454110190 - (MD) HARBORSIDE SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $531.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53454 | $506.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 53454 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53454 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 53454 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 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 |
| 53454-CPT | Low | 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 53454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53454 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 53454) and we'll show you how you compare in 15 minutes or less.