CPT 53500 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 • 51 - Multiple procedures • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $727.80 Physician Fee Schedule |
National average reimbursement for CPT 53500 by major payers:
$907.92
$1,007.35
$1,059.09
$1,251.55
| 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 53500 | ||||||
United | 53500 | $3570.00 | 1275870537 - GCSA AMBULATORY SURGERY CENTER, LLC | 611699459 - (TX) GCSA AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $3500.00 | 1275198673 - UROLOGY ASC- PHOENIX, LLC, UROLOGIC SURGERY CENTER OF ARIZONA | 320586987 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $2647.00 | 1417554155 - CENTER FOR RESTORATIVE SURGERY AT MAPLE GROVE, LLC | 853324771 - (MN) CENTER FOR RESTORATIVE SURGERY AT MAPLE GROVE LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $1902.00 | 1912252693 - ROCKWOOD CLINIC PS, ROCKWOOD EYE SURGERY CENTER | 911352172 - MULTICARE HEALTH SYSTEM | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $3570.00 | 1366444929 - EAST WEST SURGERY CENTER LP | 621797897 - (GA) EAST WEST SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $2706.00 | 1801891668 - CASCADE SPINE CENTER, LLC | 113653049 - (OR) CASCADE SPINE CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $1609.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $2800.00 | 1427144336 - PORTLAND CLINIC, THE PORTLAND CLINIC SURGICAL CENTER | 930400952 - (OR) THE PORTLAND CLINIC LLP | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $6310.00 | 1477516979 - FAIRFAX SURGICAL CENTER, L.P. | 621861640 - (VA) FAIRFAX SURGICAL CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $3347.00 | 1326527680 - INTRACOASTAL SURGERY CENTER, LLC | 824525706 - (FL) INTRACOASTAL SURGERY CENTER LL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $6342.00 | 1851650428 - TEXAS HEALTH OUTPATIENT SURGERY CENTER ALLIANCE | 822296081 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $767.00 | 1407828494 - INDEPENDENCE ASC LLC, THE ENDOSCOPY CENTER - EAST | 621707564 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $8956.00 | 1568094399 - SURGERY CENTER OF SOUTHWEST OHIO, LLC, THE SURGERY CENTER OF SOUTHWEST OHIO | 831673860 - (OH) THE SURGERY CENTER OF SOUTHWEST | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $1334.00 | 1730570003 - SMART PAIN SURGERY CENTER AT GERMANTOWN, LLC, CLEARWAY SURGERY CENTER OF GERMANTOWN | 472908671 - (MD) SMART PAIN SURGERY CENTER AT GERMANTOWN LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53500 | $2649.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | 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 53500 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53500 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 53500 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53500 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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