CPT 53852 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 22 - Increased Procedural Services • 59 - Distinct Procedural Service |
| Complexity Level | High |
| CMS | $1,289.01 Physician Fee Schedule |
National average reimbursement for CPT 53852 by major payers:
$2,063.91
$2,584.18
$2,352.76
$2,844.52
| 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 53852 | ||||||
United | 53852 | $660.00 | 1043284508 - WINTER HAVEN-SEBRING FL OPHTHALMOLOGY ASC LLC, EYE SURGERY & LASER CENTER OF SEBRING | 743072437 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $3490.00 | 1598419509 - UOI EAST BAY SURGERY CENTER LLC | 873506992 | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $2300.00 | 1336649714 - HEALTHQARE SERVICES ASC LLC, HEALTHQARE SERVICES ASC LLC | 815460194 - (VA) HEALTHQARE SERVICES ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $1500.00 | 1275740839 - EYE SURGERY CENTER OF NORTH FLORIDA LLC | 205326854 - (FL) EYE SURGERY CENTER OF NORTH FLORIDA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $3253.00 | 1699711382 - TOWSON SURGICAL CENTER LLC, TOWSON SURGICAL CENTER | 521945958 - (MD) TOWSON SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $2900.00 | 1154839678 - R&R SURGICAL INSTITUTE | 820815470 - (CA) RR SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $6846.00 | 1487012480 - LAKE SPIVEY AMBULATORY SURGERY CARE, LLC, SPIVEY STATION SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $3350.00 | 1346205481 - BLOOMINGTON EYE INSTITUTE LLC | 371361486 - (IL) BLOOMINGTON EYE INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $900.00 | 1003273129 - GREAT LAKES SURGERY CENTER LLC | 465665524 - (MI) GREAT LAKES SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $853.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $3372.00 | 1962959296 - RUSH-COPLEY SURGICENTER, LLC, CASTLE SURGICENTER | 384012268 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $827.00 | 1760423180 - CENTRAL COAST ENDOSCOPY CENTER INC | 770456846 - (CA) CENTRAL COAST ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $2689.00 | 1093449225 - NARROWS SURGERY CENTER PS | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $5079.00 | 1235770249 - WESTERN WYOMING MEDICAL LLC | 843044901 - (WY) WESTERN WYOMING MEDICAL LLC | WY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53852 | $4730.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | 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 53852 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53852 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 53852 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 |
|---|---|---|
| 53850-CPT | High | Transurethral Destruction Of Prostate Tissue; Microwave Thermotherapy |
| 53852-CPT | High | Transurethral Destruction Of Prostate Tissue; Radiofreq Thermotherapy |
| 53854-CPT | High | Destruction Of Prostate Tissue Accessed Through Urethra Using Radiofrequency Generated Water Vapor H |
| 53855-CPT | Moderate | Once Per Dos Insertion Of Temporary Prostatic Urethral Stent, Including Urethral Measurement - Deny Inv/N10=10/13/2012-4/15/2014 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53852. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53852 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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