CPT 53460 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 • SG - Scene to Hospital ESRD facility • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $447.35 Physician Fee Schedule |
National average reimbursement for CPT 53460 by major payers:
$570.83
$613.37
$649.66
$766.57
| 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 53460 | ||||||
United | 53460 | $1141.34 | 1417916800 - TULSA OK ENDOSCOPY ASC LLC, TULSA ENDOSCOPY CENTER | 203853559 - (OK) TULSA ENDOSCOPY CENTER, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $2353.00 | 1821342858 - SURGCENTER OF ORANGE PARK, LLC, ORANGE PARK ENDOSCOPY CENTER | 460858710 - (FL) SURGCENTER OF ORANGE PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $611.00 | 1649233719 - GI ASC LLC | 861122720 - (PA) GI ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1926.00 | 1720572415 - APC-AMARILLO SURGICAL OPERATING COMPANY, LLC, ADVANCED SURGICAL CENTER - AMARILLO | 822413483 - (TX) APCAMARILLO SURGICAL OPERATING COMPANY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1666.00 | 1386898435 - COLUMBIA GORGE SURGERY CENTER, LLC | 261819228 - (OR) COLUMBIA GORGE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $2408.00 | 1780610220 - PROLIANCE SURGEONS INC PS, PROLIANCE HILLSIDE MEDICAL SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1894.00 | 1568423945 - NW AMBULATORY SURGERY CENTER LLP, NW SURGERY CENTER | 383693604 - (TX) NW AMBULATORY SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1284.00 | 1619525912 - SUMMIT SURGERY CENTER MODESTO, INC | 842546051 - (CA) SUMMIT SURGERY CENTER MODESTO INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1416.00 | 1083653554 - UROLOGY SURGICAL PARTNERS, LLC | 582622573 - (GA) UROLOGY SURGICAL PARTNERS, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1505.00 | 1497727093 - BARNET DULANEY PERKINS EYE CENTER, PC, AMERICAN VISION PARTNERS | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1300.00 | 1104896422 - NORTH IDAHO PAIN CENTER LLC | 203305236 | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $825.00 | 1891784955 - PLATTSBURGH ASC LLC, CATARACT CETNER FOR THE ADIRONDACKS | 141801168 - (NY) PLATTSBURGH ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1751.00 | 1598328932 - ENDO GROUP, LLC | 200248148 - (NY) ENDO GROUP LLC DBA GARDEN CITY SURGICENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $1200.00 | 1619166097 - GPDDC, LLC | 43769350 - (NY) GPDDC, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53460 | $975.00 | 1346322187 - XRS LLC, COLUMBUS PAIN INSTITUTE | 201384877 - (IN) XRS LLC | IN | 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 53460 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53460 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 53460 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 |
| 53460-CPT | Moderate | Urethromeatoplsty,Part Excis-D.Seg |
| 53500-CPT | Moderate | Urethrolysis, Transvaginal, Secondary, Open, Including Cystourethroscopy (Eg, Postsurgical Obstruction, Scarring) |
| 53600-CPT | Low | Dilat.Ureth.Stric-Sound,Dil,Mle;1st |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53460. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53460 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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