CPT 53855 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 | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 58 - Staged or related procedure during postoperative period • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| CMS | $601.65 Physician Fee Schedule |
National average reimbursement for CPT 53855 by major payers:
$719.47
$953.83
$958.51
$1,180.68
| 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 53855 | ||||||
United | 53855 | $365.00 | 1558859645 - EAST FREEDOM SURGICAL ASSOCIATES, LLC | 820930718 - (PA) EAST FREEDOM SURGICAL ASSOCIATES LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $750.00 | 1497173801 - EHI SURGERY CENTER AUSTIN, LLC, LEGENT OUTPATIENT SURGERY - AUSTIN | 464266877 - (TX) EHI SURGERY CENTER AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $326.00 | 1538231956 - COASTAL MEDICAL CENTER LLC | 650956639 - (FL) COASTAL MEDICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $446.00 | 1225458755 - AOS SURGERY CENTER LLC | 464197221 - (GA) AOS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $934.00 | 1255361259 - CENTRAL JERSEY SURGERY CENTER LLC, CENTRAL JERSEY SURGERY CENTER | 582352848 - (NJ) CENTRAL JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $1093.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $893.00 | 1942507488 - GA ENDOSCOPY CENTER, LLC | 273115800 - (GA) GA ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $1655.00 | 1801179619 - SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | 273075822 - (NJ) SURGICARE OF FREEHOLD LIMITED LIABILITY COMPANY | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $2026.00 | 1306472063 - THE EMORY CLINIC INC, EMORY ENDOSCOPY CENTER AT DECATUR | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $350.00 | 1730382789 - ENDOSCOPY CENTER | 260317060 - (NC) ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $1490.00 | 1962663559 - GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC | 262157335 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $1021.00 | 1891750980 - AMBULATORY SURGICAL FACILITY OF S FLORIDA LLLP, MEMORIAL SAME DAY SURGERY CENTERS | 592753716 - (FL) AMBULATORY SURGICAL FACILITY OF | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $1283.00 | 1447364682 - RIDGE VIEW ENDOSCOPY CENTER | 800688043 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $275.00 | 1891313532 - ROCKINGHAM EYE SURGERY CENTER, LLC | 842294161 - (VA) ROCKINGHAM EYE SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53855 | $500.00 | 1750694832 - SURGICARE ASSOCIATES, LLC | 272802420 - (PA) SURGICARE ASSOCIATES LLC | PA | 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 53855 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53855 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 53855 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 53855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53855 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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