CPT 53505 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| CMS | $475.49 Physician Fee Schedule |
National average reimbursement for CPT 53505 by major payers:

$636.05

$653.03

$676.98

$816.20
| 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 53505 | ||||||
United | 53505 | $2000.00 | 1982931465 - GARDEN GROVE SURGICAL CENTER INC | 271203227 - (CA) GARDEN GROVE SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1100.00 | 1376641670 - AMBULATORY SURGERY CENTER OF GREATER NEW YORK, LLC | 133418924 - (NY) AMBULATORY SURGERY CENTER OF GREATER NEW YORK, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $2016.00 | 1063437994 - TRI-CITIES ENDOSCOPY CENTER PC, THE CENTER FOR DIGESTIVE WELLNESS | 621867929 - (TN) TRICITIES ENDOSCOPY CENTER PC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $2307.00 | 1083873277 - VENTURE AMBULATORY SURGERY CENTER LLC | 743257508 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $753.00 | 1447212337 - PUGET SOUND GASTROENTEROLOGY, PLLC, EVERGREEN ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $4140.00 | 1548238140 - DENTON SURGICARE PARTNERS LTD, BAYLOR SCOTT & WHITE SURGICARE - DENTON | 752708579 - (TX) DENTON SURGICARE PARTNERS LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1726.00 | 1619244175 - BARRINGTON PAIN AND SPINE INSTITUTE, LLC, BARRINGTON AMBULATORY SURGERY CENTER | 273091392 - (IL) BARRINGTON PAIN AND SPINE INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $744.00 | 1659903292 - RACINE DIGESTIVE HEALTH CENTER LLC | 844211105 - (WI) RACINE DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1410.00 | 1528000817 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1665.00 | 1942261599 - SDOSC, LP, SAN DIEGO OUTPATIENT AMBULATORY SURGICAL CENTER | 30506487 - (CA) SDOSC, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $2200.00 | 1609977610 - UOC SURGICAL SERVICES, LTD. | 251890694 - (PA) UOC SURGICAL SERVICES LTD | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1222.00 | 1063445542 - TOTAL PAIN CARE LLC | 202484443 - (MS) TOTAL PAIN CARE, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $3623.00 | 1376727214 - PROLIANCE SURGEONS INC PS, PROLIANCE SOUTHWEST SEATTLE SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $1469.00 | 1043246077 - DUTCHESS AMBULATORY SURGICAL CENTER | 141803011 - (NY) DUTCHESS AMBULATORY SURGICAL CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53505 | $4284.00 | 1013962521 - NEWPORT PLAZA SURGERY CENTER | 392060266 | CA | 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 53505 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53505 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 53505 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 53505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53505 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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