Average Charge and Payment Data for 15 Urology Procedures Commonly Performed in ASCs

Here is the average 2007 Medicare sub charge (submitted charges divided by allowed services), average allow charge (Medicare-allowed charges divided by allowed services, including co-pays and deductibles paid by patient), and average payment (Medicare payments divided by allowed services, not including co-pays and deductibles paid by patient) for 15 urology procedures commonly performed in ASCs.

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1. Scope of bladder and urethra, for diagnosis (CPT 52000)
– average sub charge: $963
– average allow charge $328
– average payment: $257

2. Scope bladder, insert tube for injection (CPT 52005)
– average sub charge: $2,164
– average allow charge $388
– average payment: $306

3. Scope bladder, removal of lesions, small (CPT 52224)
– average sub charge: $2,104
– average allow charge $430
– average payment: $339

4. Scope bladder, removal of tumors, small (CPT 52234)
– average sub charge: $2,381
– average allow charge $439
– average payment: $347

5. Scope bladder, opening of bladder (CPT 52260)
– average sub charge: $2,106
– average allow charge $428
– average payment: $337

6. Scope bladder, open narrowed female urethra (CPT 52285)
– average sub charge: $1,291
– average allow charge $440
– average payment: $348

7. Scope bladder, simple removal stone, stent (CPT 52310)
– average sub charge: $1,520
– average allow charge $389
– average payment: $306

8. Scope bladder, complex removal stone, stent (CPT 52315)
– average sub charge: $2,534
– average allow charge $440
– average payment: $348

9. Scope bladder & ureter, insert stent into ureter (CPT 52332)
– average sub charge: $2,481
– average allow charge $352
– average payment: $279

10. Scope bladder & ureter, remove or move stones (CPT 52352)
– average sub charge: $3,085
– average allow charge $609
– average payment: $480

11. Scope bladder & ureter, break up kidney stone (CPT 52353)
– average sub charge: $3,808
– average allow charge $610
– average payment: $483

12. Surgery on bladder neck through urethra (CPT 52500)
– average sub charge: $2,585
– average allow charge $493
– average payment: $389

13. Opening of post-operative bladder neck narrowing (CPT 52640)
– average sub charge: $2,609
– average allow charge $437
– average payment: $348

14. Laser coagulation of prostate for urine flow (CPT 52647)
– average sub charge: $3,746
– average allow charge $1,316
– average payment: $1,044

15. Laser vaporization of prostate for urine flow (CPT 52648)
– average sub charge: $5,819
– average allow charge $1,330
– average payment: $1,048

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