CPT 53515 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • 22 - Increased Procedural Services |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53515 |
National average reimbursement for CPT 53515 by major payers:
$1,002.90
$1,074.66
$1,093.49
$1,331.17
| 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 53515 | ||||||
United | 53515 | $1175.00 | 1629107545 - LANIER EYE ASSOCIATES, LLC, ADVANCED EYE SURGERY AND LASER CENTER | 50559435 - (GA) LANIER EYE ASSOCIATES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $2647.00 | 1518505809 - MAPLE GROVE CENTER FOR RESTORATIVE SURGERY | 853324771 - (MN) CENTER FOR RESTORATIVE SURGERY AT MAPLE GROVE LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1944.00 | 1275231466 - ADVANCED JOINT AND SPINE INSTITUTE-ORLANDO, LLC | 872644888 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $2500.00 | 1124029384 - LGH-A/GOLF ASTC, LLC, GOLF SURGICAL CENTER | 363468942 - (IL) LGH-AGOLFASTCLLC.DBAGOLF SURGICAL CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1998.00 | 1285664466 - NEWPORT MULTI SPECIALTY SURGERY CENTER LLC | 842619042 - (CA) NEWPORT MULTI SPECIALTY SURGER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $2243.00 | 1689349219 - EVEREST ASC | 861747710 - (ID) EVEREST ASC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $4140.00 | 1023420577 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1181.47 | 1275687873 - DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC | 610701663 - (KY) DERMATOLOGY ASSOCIATES OF KENTUCKY, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1980.00 | 1659420727 - THE ENDOSCOPY CENTER, INC. | 460450119 - (SD) THE ENDOSCOPY CENTER INC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $2902.00 | 1003976929 - THE ORTHOPAEDIC SURGERY CENTER LLC | 208356016 - (WI) THE ORTHOPAEDIC SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $908.50 | 1700967106 - EBSC, LLC, SURGICAL CARE CENTER OF MICHIGAN | 382840421 - (MI) EBSC LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $3570.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1100.00 | 1528080876 - FRY EYE SURGERY CENTER, LLC | 742823718 - (KS) FRY EYE SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $3500.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53515 | $1280.00 | 1003889346 - ENDOSCOPY GROUP LLC | 593519881 - (FL) ENDOSCOPY GROUP, LLC | FL | 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 53515 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53515 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 53515 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 |
|---|---|---|
| 53431-CPT | High | Urethroplasty With Tubularization Of Posterior Urethra And/Or Lower Bladder For Incontinence (Eg, Tenago, Leadbetter Procedure) |
| 53502-CPT | Moderate | Urethrorrhaphy Female |
| 53505-CPT | Moderate | Urethrorr,Suture Ureth.Wound;Penile |
| 53515-CPT | High | Urethrorrhaphy;Prostatomembranous |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53515. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53515 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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