CPT 53860 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 |
| Common Modifiers | • None |
| Complexity Level | High |
| CMS | $2,197.30 Physician Fee Schedule |
National average reimbursement for CPT 53860 by major payers:
$2,227.46
$2,447.87
$2,842.42
$3,586.54
| 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 53860 | ||||||
United | 53860 | $820.00 | 1255332805 - PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER LLC, DIGESTIVE DISEASE ENDOSCOPY CENTER | 50540368 - (IL) PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1245.00 | 1336562156 - RYE SURGICAL CENTER, LLC | 463464240 - (NH) RYE SURGICAL CENTER LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $814.00 | 1881461705 - GLACIER SURGICAL CENTER, LLC | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $658.00 | 1447271713 - COLUMBUS ORTHOPEDIC OUTPATIENT | 900069344 - (MS) COLUMBUS ORTHOPEDIC OUTPATIENT | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $577.00 | 1407993132 - DIGESTIVE DISEASE ENDOSCOPY CENTER | 352597463 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $675.00 | 1356814958 - CLEVELAND CHILDRENS SURGERY CENTER LLC | 301128634 - (OH) CLEVELAND CHILDRENS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $3236.20 | 1386962223 - KELLI MATHEW | 350593390 - DEACONESS HOSPITAL INC | KY | Pulmonary Disease Physician (207RP1001X) |
United | 53860 | $941.00 | 1114584786 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $328.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $417.00 | 1275836645 - BROOKSTONE AMBULATORY SURGERY CENTER | 263097292 - (GA) BROOKSTONE AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $950.00 | 1811076623 - SPARTANBURG SURGERY CENTER, LLC | 570953005 - (SC) SPARTANBURG SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $543.00 | 1447661145 - ADVANCED OUTPATIENT SURGERY OF OKLAHOMA, LLC | 371751472 - (OK) ADVANCED OUTPATIENT SURGERY OF | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1000.00 | 1700400850 - FALCONHEAD SURGERY CENTER LLC | 844342209 - (TX) FALCONHEAD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $335.00 | 1164719209 - SURGICAL SPECIALISTS OF ST LUCIE, BLUE WATER SURGERY CENTER | 260176703 - (FL) SURGICAL SPECIALISTS OF ST. LUCIE COUNTY, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1544.00 | 1407851090 - WICHITA FALLS ENDOSCOPY CENTER | 200474975 - (TX) WICHITA FALLS ENDOSCOPY CENTER | TX | 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 53860 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53860 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 53860 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 |
| 53860-CPT | High | Once Per Dos Transurethral Radiofrequency Micro-Remodeling Of The Female Bladder Neck & Proximal Urethra For Stress Urinary Incontinence- Deny Inv/N10 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53860 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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