CPT 53520 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 • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Moderate |
| CMS | $546.33 Physician Fee Schedule |
National average reimbursement for CPT 53520 by major payers:
$742.07
$747.67
$810.89
$935.38
| 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 53520 | ||||||
United | 53520 | $650.00 | 1932207669 - EYE SURGICAL CENTER OF MISSISSIPPI | 200669972 - (MS) EYE SURGICAL CENTER OF MISSISSIPPI | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $788.00 | 1104833839 - ROCHESTER SURGERY CENTER, P.C. | 200510602 - (MI) ROCHESTER SURGERY CENTER PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $3535.00 | 1710037452 - ILLINOIS SPORTS MEDICINE & ORTHOPEDIC SURGERY CENTER, LLC | 201054630 - (IL) ILLINOIS SPORTS MEDICINE AND ORTHOPEDIC SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $3623.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $2200.00 | 1194959809 - BEVERLY HILLS REGIONAL SURGERY CENTER LP | 263718069 - (CA) BEVERLY HILLS REGIONAL SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $3623.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $4633.00 | 1699738112 - NORTH AUSTIN SURGERY CENTER, L.P. | 200648730 - (TX) NORTH AUSTIN SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $6223.00 | 1740236454 - PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC, PRINCESS ANNE AMBULATORY SURGERY CENTER | 204920880 - (VA) PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $1035.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 470920340 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $1595.00 | 1518272087 - SIPI AMBULATORY SURGERY CENTER | 300638923 - (ID) SIPI AMBULATORY SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $2425.00 | 1255896676 - ASCENTIST ASC MERRIAM, LLC, ASCENTIST EAR, NOSE AND THROAT INSTITUTE | 831973214 - (KS) ASCENTIST ASC MERRIAM LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $2882.00 | 1881015584 - ACE ENDOSCOPY AND SURGERY CENTER | 464212208 - (CA) ACE ENDOSCOPY & SURGERY CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $1800.00 | 1649893934 - SIMI VALLEY SURGERY CENTER INC | 841997544 - (CA) SIMI VALLEY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $2248.00 | 1366868572 - PREMIER SURGERY CENTER, LLC | 463321793 - (NC) PREMIER SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53520 | $3580.00 | 1346845138 - SURGERY CENTER AT COTTONWOOD, LLC | 854085692 - (UT) SURGERY CENTER AT COTTONWOOD LLC | UT | 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 53520 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53520 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 53520 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) |
| 53442-CPT | High | Remov Perineal Prosth.For Continenc |
| 53510-CPT | Moderate | Urethrorrhaphy Perineal |
| 53520-CPT | Moderate | Close Urethrostomy/Cutan Fist Male |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53520 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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