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 |
| Medicare Fee Schedule | View Medicare rates for 53860 |
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 | $1258.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1233.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $725.00 | 1053846592 - EASTSIDE ENDOSCOPY CENTER LLC | 810759895 - (GA) EASTSIDE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $985.00 | 1366065674 - SOUTH DENVER SURGICAL SERVICES LLC, SOUTH DENVER UROLOGY CENTER | 850873977 - (CO) SOUTH DENVER SURGICAL SERVICES LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1375.00 | 1811262363 - PRECISION SURGERY CENTER, LLC | 453655088 - (KS) PRECISION SURGERY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1714.00 | 1164513149 - ENDO-SURGI OF UNION ASC LLC | 223248249 - (NJ) ENDO-SURGI CENTER, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $514.00 | 1659340404 - LITTLE ROCK SURGERY CENTER, LLC | 203687986 - (AR) LITTLE ROCK SURGERY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $688.00 | 1447613344 - PREMIER SURGICAL CENTER LLC | 811222482 - (MO) PREMIER SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
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 | $758.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $575.00 | 1750920591 - HAYDEN SURGICAL CENTER LLC | 844085494 - (AZ) HAYDEN SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $625.00 | 1093993727 - CAROLINA MOUNTAIN GASTROENTEROLOGY ENDOSCOPY CENTER | 261708694 - (NC) CAROLINA MOUNTAIN GASTROENTEROLOGY ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1179.00 | 1427003052 - EYE SURGERY CENTER OF NASHVILLE LLC | 621872622 - (TN) EYE SURGERY CENTER OF NASHVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $1258.00 | 1992796742 - SAN ANTONIO ENDOSCOPY, LP, SAN ANTONIO ENDOSCOPY CENTER | 202511329 - (TX) SAN ANTONIO ENDOSCOPY LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 53860 | $487.00 | 1992784821 - EYE SURGERY CENTER OF CHESTER COUNTY, LLC, VISION ONE LASER & SURGERY CENTER | 232922796 - (PA) EYE SURGERY CENTER OF CHESTER COUNTY, 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 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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