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See a sample rate comparisonCPT 53860 Fee Schedule
Last Verified: October 2026
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.
Surgery For Bladder Control, Surgery To Relieve Stress Incontinence (Urine Leakage). The Procedure May Modify The Bladder Muscles Or The Bladder Opening And Urethra.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Common Place of Service | 11 - Office |
| Common Modifiers | None |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53860 |
| Medicaid Fee Schedule | View Medicaid rates for 53860 |
National average reimbursement for CPT 53860 by major payers:
$2,227.46
$2,447.87
$2,842.42
$3,416.15
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CPT 53860
5 of 25 sample ratesHigher to lower in this preview
Endo-Surgi Of Union Asc LLC
Endo-Surgi Center, P.A.
$1,714.00Published rateEye Surgery Center Of Nashville LLC
$1,179.00Published ratePrairieland Outpatient Diagnostic Center LLC, Digestive Disease Endoscopy Center
Prairieland Outpatient Diagnostic Center, LLC
$820.00Published rateCarolina Mountain Gastroenterology Endoscopy Center
$625.00Published rateCenter For Eye Surgery, LLC
Center For Eye Surgery LLC
$413.00Published rate
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See a sample payer proposalCPT 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 | Transurethr Destruct Of Prostat Tissue; By Microwav Thermothera, Transurethral Destruction Of Prostate Tissue; By Microwave Thermothera |
| 53852-CPT | High | Transurethr Destruct Of Prostat Tissue; By Radiofrequ Thermo, Transurethral Destruction Of Prostate Tissue; By Radiofrequency Thermo |
| 53854-CPT | High | Trurl Dstrj Prst8 Tiss Rf Wv, Destruction Of Prostate Tissue Accessed Through Urethra Using Radiofrequency Generated Water Vapor Heat Therapy |
| 53860-CPT | High | Surgery For Bladder Control, Surgery To Relieve Stress Incontinence (Urine Leakage). The Procedure May Modify The Bladder Muscles Or The Bladder Opening And Urethra. |
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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