CPT 57265 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 Female Genital System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
National average reimbursement for CPT 57265 by major payers:
$1,085.25
$1,167.50
$1,187.93
$1,442.44
| 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 57265 | ||||||
United | 57265 | $2836.00 | 1255345229 - BEACON ORTHOPAEDICS SURGERY CENTER, LLC, SUMMIT SURGERY CENTER | 311800570 - (OH) BEACON ORTHOPAEDICS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $5820.00 | 1366446189 - PARKWAY SURGERY CENTER, LLC., PARKWAY SURGERY CENTER | 880403777 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $1473.00 | 1689636219 - FLORIDA OUTPATIENT SURGERY CENTER LTD | 752457259 - (FL) FLORIDA OUTPATIENT SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $5354.00 | 1881969269 - SURGERY CENTRE OF SW FLORIDA LLC, CAPE HEALTH SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $1141.00 | 1447442876 - MAPLE SPRINGS PODIATRIC SURGICAL CENTER, INC | 521883407 - (MD) MAPLE SPRINGS PODIATRIC SURGICAL CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $1050.00 | 1750920591 - HAYDEN SURGICAL CENTER LLC | 844085494 - (AZ) HAYDEN SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $4566.00 | 1760875983 - BAPTIST MEDICAL PARK SURGERY CENTER, LLC | 593535262 - (FL) BAPTIST MEDICAL PARK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $774.00 | 1285633818 - FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | 522208568 - (MD) FOUR CORNERS AMBULATORY SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $1513.80 | 1609038868 - CHAD LINK | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 57265 | $4472.00 | 1558627406 - CARMEL SPECIALTY SURGERY CENTER LLC | 454729527 - (IN) CARMEL SPECIALTY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $2800.00 | 1730540600 - RICHMOND ASC LLC, RICHMOND PAIN MANAGEMENT ASC | 472882195 - (NY) RICHMOND ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $5922.00 | 1811318785 - CONNECTICUT ORTHOPAEDIC SPECIALISTS OUTPATIENT SURGICAL CENTER LLC | 462819773 | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $3077.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $1588.00 | 1841255775 - DUBUQUE ENDOSCOPY CENTER LC | 201597161 - (IA) DUBUQUE ENDOSCOPY CENTER LC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 57265 | $2888.00 | 1558497263 - ARTHUR N DONALDSON M D INC, SONORA EYE SURGERY CENTER | 942593611 - ARTHUR N DONALDSON MD INC | CA | 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 57265 vs. Other Surgical Procedures on the Female Genital System Codes
The CPT 57265 code is part of the Surgery services used for Surgical Procedures on the Female Genital 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 57265 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 |
|---|---|---|
| 57220-CPT | Moderate | Sphincteroplasty Urethra |
| 57230-CPT | Moderate | Repair Urethrocele |
| 57240-CPT | Moderate | Anterior Colporrhaphy Repair Of Cystocele With Orwithout Repair Of Urethrocele Including Cystourethroscopy When Performed (Desc Revised 1/1/2018) |
| 57265-CPT | High | Combined Anteroposterior Colporrhaphy Including Cysoturethroscopy When Performed; With Enterocele Repair (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 57265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 57265 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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