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 |
| Medicare Fee Schedule | View Medicare rates for 53605 |
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 | $1400.00 | 1063058303 - CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH, LLC | 843621271 - (VA) CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $675.00 | 1215489182 - CORONADO SURGERY CENTER LLC | 814244748 - (AZ) CORONADO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $812.00 | 1699711382 - TOWSON SURGICAL CENTER LLC, TOWSON SURGICAL CENTER | 521945958 - (MD) TOWSON SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $480.00 | 1013513308 - JOHN KENYON AMERICAN EYE INSTITUTE LLC, EYE SURGERY CENTER OF ELIZABETHTOWN | 351907389 - JOHN-KENYON AMERICAN EYE INSTITUTE | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $443.00 | 1497201867 - ABILENE CENTER FOR ORTHOPEDIC AND MULTISPECIALTY SURGERY, L.L.C. | 813619502 - (TX) ABILENE CENTER FOR ORTHOPEDIC AND MULTISPECIALTY SURGERY LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $714.00 | 1720081870 - ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC, OASIS | 582398485 - (OH) ORTHOPAEDIC AMBULATORY SURGICAL INTERVENTION SERVICES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $910.00 | 1053688036 - SUNSET SURGICAL CENTRE LLC | 270224735 - (OR) SUNSET SURGICAL CENTRE LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $959.00 | 1417958729 - MENTOR SURGERY CENTER LTD | 341863257 - (OH) MENTOR SURGERY CENTER,LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $1179.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $3405.88 | 1780919043 - SURGERY CENTER OF EDGEWOOD PLACE, LLC, LAWRENCE COUNTY SURGERY CENTER OF EDGEWOOD SURGICAL HOSPITAL | 481256749 - (PA) SURGERY CENTER AT EDGEWOOD PLACE, LLC DBA EDGEWOOD SURGICAL HOSPITAL | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $2817.00 | 1598096802 - MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC, MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER | 264276930 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $867.00 | 1851407795 - NORTHERN ILLINOIS SURGERY CENTER LIMITED PATRNERSHIP, THE CENTER FOR SURGERY | 363776424 - (IL) NORTHERN ILLINOIS SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53605 | $2172.00 | 1760912554 - BAYLOR SURGICARE AT BAYLOR PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE AT PLANO ALLIANCE | 813127185 - (TX) BAYLOR SURGICARE AT BAYLOR PLANO LLC | TX | 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 | $681.00 | 1174128359 - JEFFERSON ASC, LLC, VOLUNTEER SURGERY CENTER | 364934272 - (TN) JEFFERSON ASC LLC | TN | 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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