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See a sample rate comparisonCPT 53520 Fee Schedule
Last Verified: October 2026
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.
Closur Of Urethrostomy Or Urethrocutaneous Fistula Male, Closure Of Urethrostomy Or Urethrocutaneous Fistula Male (Separate Pr
| 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 |
| Medicare Fee Schedule | View Medicare rates for 53520 |
| Medicaid Fee Schedule | View Medicaid rates for 53520 |
National average reimbursement for CPT 53520 by major payers:
$742.07
$747.67
$810.89
$912.67
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CPT 53520
5 of 25 sample ratesHigher to lower in this preview
Trident Ambulatory Surgery Center, L.P.
Trident Ambulatory Surgery Center Lp
$7,402.00Published rateFirst Hill Surgery Center LLC
$2,920.00Published rateNortheast Endoscopy LLC
$1,906.00Published rateAu Surgery Center, LLC
Au Surgery Center LLC
$1,440.00Published rateTampa Surgery Center LLC
$899.00Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 53442-CPT | High | Incontinence Surgery Revision, Surgery To Remove Or Revise A Sling That Was Inserted For Bladder Control. The Sling Material Supports The Urethra Muscles. |
| 53510-CPT | Moderate | Urethrorrhaphy Perineal |
| 53520-CPT | Moderate | Closur Of Urethrostomy Or Urethrocutaneous Fistula Male, Closure Of Urethrostomy Or Urethrocutaneous Fistula Male (Separate Pr |
| 53620-CPT | Low | Dilation Of Urethral Strictur, Dilation Of Urethral Stricture By Passage Of Filiform Andfollower Male Initial Dilation Of Urethral Stricture By Passage Of Filiform And |
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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