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See a sample rate comparisonCPT 53865 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.
Insert Device Into Bladder, A Scope Exam Of The Bladder (Cystourethroscopy). The Procedure Includes Inserting A Temporary Device To Reshape The Bladder Neck And The Prostate.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Urinary System |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 53865 |
| Medicaid Fee Schedule | View Medicaid rates for 53865 |
National average reimbursement for CPT 53865 by major payers:
$3,737.11
$4,120.10
$3,227.53
$589.05
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CPT 53865
5 of 25 sample ratesHigher to lower in this preview
The Endoscopy Center At St. Francis, LLC
The Endoscopy Center At St Francis LLC
$6,489.00Published rateHastings Surgical Center, LLC, Hastings Surgical Center
Hastings Surgical Center LLC
$1,108.00Published rateOrthotec Surgery Center, Inc, Elmhurst Foot & Ankle Surgery Center, Inc
Orthotec Surgery Center Inc
$800.00Published rateGastroenterology & Hepatology Consultants, PA, Wake Forest Endoscopy Center
Gastroenterology And Hepatology Consultants, P.A.
$400.00Published rateCentral Ohio Endoscopy Center, LLC
Central Ohio Endoscopy Center LLC
$257.00Published rate
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See a sample payer proposalCPT 53865 vs. Other Surgical Procedures on the Urinary System Codes
The CPT 53865 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 53865 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 |
|---|---|---|
| 53865-CPT | High | Insert Device Into Bladder, A Scope Exam Of The Bladder (Cystourethroscopy). The Procedure Includes Inserting A Temporary Device To Reshape The Bladder Neck And The Prostate. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 53865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 53865 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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