CPT 53854 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 • GC - Service performed by resident under supervision • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | High |
| CMS | $1,551.02 Physician Fee Schedule |
National average reimbursement for CPT 53854 by major payers:
$1,946.39
$2,406.85
$2,503.51
$2,941.54
| 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 53854 | ||||||
United | 53854 | $1333.00 | 1427005313 - WESTERN WASHINGTON MEDICAL GROUP, INC PS, WESTERN WASHINGTON MEDICAL GROUP ENDOSCOPY CENTER | 911602128 - (WA) WESTERN WASHINGTON MEDICAL GROUP, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $2450.00 | 1376536482 - BEND SURGERY CENTER LLC, BEND SURGERY CENTER | 911772048 - (OR) BEND SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $900.00 | 1881151108 - ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | 833191352 - (GA) ALLIANCE SURGERY CENTER AT JOHNS CREEK LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $1530.00 | 1396065082 - PAIN CENTERS OF MINNESOTA-MANKATO, LLC | 272452351 - (MN) PAIN CENTERS OF MINNESOTA-MANKATO, LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $504.00 | 1992700090 - TAMPA BAY SPECIALTY SURGERY CENTER LLC, TAMPA BAY SPECIALTY SURGERY CENTER | 331019420 - (FL) TAMPA BAY SPECIALTY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $2206.00 | 1912265653 - BRASELTON ENDOSCOPY CENTER, LLC | 453369410 - (GA) BRASELTON ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $900.00 | 1104998558 - AMERICAN EYE SURGERY CENTER, INC. | 203774302 - (GA) AMERICAN EYE SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $1611.00 | 1396213294 - UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | 831320776 - (OH) UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $1307.00 | 1356463913 - MODESTO SURGERY CENTER LLC | 770394007 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $1250.00 | 1104072453 - MACON OUTPATIENT SURGERY INC | 203027560 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $6649.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $1207.00 | 1588765739 - NORTHWEST ENDOSCOPY CENTER, LLC | 911919202 - (WA) NORTHWEST ENDOSCOPY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $787.00 | 1679602544 - TGH SURGERY CENTER AT MORSANI, LLC, TGH SURGERY CENTER | 871193981 - (FL) TGH SURGERY CENTER AT MORSANI LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $806.00 | 1447366224 - WEST MICHIGAN SURGERY CENTER, LLC | 371509502 - (MI) MICHIGAN PRIMARY CARE PARTNERS PC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53854 | $475.00 | 1962869446 - FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER, LLC | 473997859 - (NC) FAYETTEVILLE GASTROENTEROLOGY ENDOSCOPY CENTER LLC | NC | 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 53854 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53854 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 53854 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 53854. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53854 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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