CPT 53605 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 | Low |
| CMS | $61.46 Physician Fee Schedule |
National average reimbursement for CPT 53605 by major payers:
$88.24
$87.79
$90.01
$107.83
| 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 53605 | ||||||
United | 53605 | $725.00 | 1003369216 - CRESTVIEW HILLS SURGERY CENTER, PLLC, ICAN | 273003180 - (KY) MICHAEL FLETCHER MD PLLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $584.00 | 1265435614 - ANMED HEALTH MEDICUS SURGERY CENTER LLC, MEDICUS SURGERY CENTER, INC. | 542189833 - (SC) ANMED HEALTH MEDICUS SURGERY CENTER, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $611.00 | 1417114166 - STONECREEK SURGERY CENTER LLC | 412275749 - (NV) STONECREEK SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $425.00 | 1598848632 - SAN MATEO SURGERY CENTER | 510655329 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $425.00 | 1356718514 - WACO AMBULATORY SURGERY CENTER, LP, WACO CARDIOLOGY CATH LAB & SURGERY CENTER | 473337811 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $661.00 | 1861496564 - DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER | 582406657 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $530.00 | 1780923128 - MACOMB ENDOSCOPY CENTER PLC | 275015226 - (MI) MACOMB ENDOSCOPY CENTER PLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $425.00 | 1396123865 - SOUND SURGEONS PLLC, NORTHWEST WEIGHT LOSS SURGERY | 461190829 - (WA) SOUND SURGEONS, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1886.00 | 1851029060 - COLORADO SPRINGS SURGICENTER, LLC | 862813124 - COLORADO SPRINGS SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1276.00 | 1114253093 - CRESCENT CITY SURGERY CENTER LLC | 271113561 - (IN) CRESCENT CITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1179.00 | 1821036138 - GAMMA SURGERY CENTER LLC | 270128900 - (PA) GAMMA SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1300.00 | 1043760184 - AUBURN SURGERY CENTER INC | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $339.00 | 1619213303 - RIVERSIDE ENDOSCOPY CENTER LLC | 461567697 - (FL) RIVERSIDE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1160.00 | 1285251132 - WEST BOZEMAN SURGERY CENTER, LLC, BOZEMAN OUTPATIENT SURGERY CENTER | 371912708 - (MT) WEST BOZEMAN SURGERY CENTER LLC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $600.00 | 1912412420 - GALEA CENTER, LLC., GALEA CENTER FOR ADVANCED SURGERY | 821939476 - (CA) GALEA CENTER LLC | 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 53605 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53605 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 53605 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 |
|---|---|---|
| 53450-CPT | Moderate | Urethromeatoplasty W Mucosal Advanc |
| 53600-CPT | Low | Dilat.Ureth.Stric-Sound,Dil,Mle;1st |
| 53601-CPT | Low | Dil Urethra W Sound Male Subseq |
| 53605-CPT | Low | Dilation Of Urethral Stricture Or Vesical Neck By Passage Of Sound Or Urethral Dilator, Male, General Or Conduction (Spinal) Anesthesia |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53605 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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